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General NPI Number Information
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NPI Number | 1568919025
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Entity Type | Organization
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Legal Business Name | SCOTT G SMORON DDS MSD LTD
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 421 W. PROSPECT AVE.
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056
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Country | US
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Telephone | 847-255-2526
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Fax |
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Provider Business Mailing Address
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Address Line | 421 W. PROSPECT AVE.
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056
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Country | US
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Telephone | 847-255-2526
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Fax |
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Authorized Official
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Title or Position | DOCTOR, OWNER, PRESIDENT
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Name | DR. SCOTT G SMORON
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Credential | DDS MSD
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Telephone | 847-255-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021.002000
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License Number State | IL
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