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General NPI Number Information
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NPI Number | 1740649193
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Entity Type | Organization
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Legal Business Name | SMILE MORE DENTAL 3 CORP
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Dates
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Enumeration Date | 02/14/2016
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Last Update Date | 02/14/2016
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Provider Practice Location Address
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Address Line | 1480 N ORCHARD RD #104
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City | AURORA
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State | IL
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Zip | 60506-7939
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Country | US
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Telephone | 630-343-0543
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Fax |
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Provider Business Mailing Address
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Address Line | 1480 N ORCHARD RD #104
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City | AURORA
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State | IL
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Zip | 60506-7939
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMI MOHAMED DIAB
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Credential | DDS
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Telephone | 312-451-7264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | 019027963
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License Number State | IL
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