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General NPI Number Information
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NPI Number | 1770306599
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Entity Type | Organization
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Legal Business Name | SMILE FAMILY DENTAL JOLIET PC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 110 N LARKIN AVE
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City | JOLIET
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State | IL
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Zip | 60435-6603
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Country | US
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Telephone | 630-788-9489
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Fax |
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Provider Business Mailing Address
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Address Line | 252 CLAREMONT DR
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City | NAPERVILLE
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State | IL
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Zip | 60540-4484
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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 | WOOYOUNG CHOI
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Credential |
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Telephone | 630-788-9489
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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 |
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License Number State |
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