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General NPI Number Information
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NPI Number | 1750096806
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Entity Type | Organization
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Legal Business Name | AMBER SMILES
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 459 W DIVISION ST UNIT 611
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City | CHICAGO
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State | IL
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Zip | 60610-2595
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Country | US
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Telephone | 773-658-4132
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Fax |
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Provider Business Mailing Address
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Address Line | 459 W DIVISION ST UNIT 611
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City | CHICAGO
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State | IL
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Zip | 60610-2595
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Country | US
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Telephone | 773-658-4132
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | AMBER D BARDLETT
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Credential |
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Telephone | 773-658-4132
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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 |
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License Number State |
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