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General NPI Number Information
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NPI Number | 1730574641
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Entity Type | Organization
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Legal Business Name | SMILE CENTER OF BROOKFIELD
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 9144 BROADWAY AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1304
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Country | US
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Telephone | 708-485-7754
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Fax | 708-485-6454
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Provider Business Mailing Address
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Address Line | 9144 BROADWAY AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1304
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Country | US
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Telephone | 708-485-7754
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Fax | 708-485-6454
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | DR. TATIANA S PAUNESCU
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Credential | DDS
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Telephone | 708-485-7754
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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 | 019024077
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License Number State | IL
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