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General NPI Number Information
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NPI Number | 1669880258
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Entity Type | Organization
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Legal Business Name | ANGEL SMILE DENTAL CARE, PC
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Dates
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Enumeration Date | 07/26/2014
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Last Update Date | 07/26/2014
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Provider Practice Location Address
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Address Line | 2352 S ELMHURST RD
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City | MT PROSPECT
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State | IL
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Zip | 60056-5805
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Country | US
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Telephone | 773-968-9864
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Fax | 847-979-8370
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Provider Business Mailing Address
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Address Line | 2352 S ELMHURST RD
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City | MT PROSPECT
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State | IL
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Zip | 60056-5805
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Country | US
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Telephone | 773-968-9864
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Fax | 847-979-8370
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Authorized Official
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Title or Position | OWNER
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Name | DR. VASYL M BARANOVSKY
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Credential | DDS
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Telephone | 847-621-2287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028276
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License Number State | IL
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