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General NPI Number Information
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NPI Number | 1639677040
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Entity Type | Organization
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Legal Business Name | ATTAINABLE SMILES DENTAL
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 1124 BLOOMINGDALE RD
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City | GLENDALE HEIGHTS
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State | IL
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Zip | 60139-3498
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Country | US
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Telephone | 630-260-9898
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Fax |
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Provider Business Mailing Address
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Address Line | 1124 BLOOMINGDALE RD
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City | GLENDALE HEIGHTS
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State | IL
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Zip | 60139-3498
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Country | US
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Telephone | 630-260-9898
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TOMMY JOHN CASTILLO SAGADRACA
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Credential | DMD
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Telephone | 630-260-9898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019030727
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License Number State | IL
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