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General NPI Number Information
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NPI Number | 1700946001
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Entity Type | Organization
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Legal Business Name | ALL SMILES FAMILY DENTAL CARE, INC.
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Dates
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Enumeration Date | 12/10/2006
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 1705 W BOUGHTON RD
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City | BOLINGBROOK
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State | IL
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Zip | 60490-1550
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Country | US
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Telephone | 630-226-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 W BOUGHTON RD
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City | BOLINGBROOK
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State | IL
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Zip | 60490-1550
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Country | US
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Telephone | 630-226-9700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | POONAM B. WADHWANI
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Credential | DDS
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Telephone | 630-935-2168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-025368
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License Number State | IL
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