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General NPI Number Information
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NPI Number | 1770356529
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Entity Type | Organization
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Legal Business Name | CU SMILE DENTAL
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 302 E SAINT CHARLES RD STE A
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City | VILLA PARK
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State | IL
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Zip | 60181-2473
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Country | US
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Telephone | 630-339-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 302 E SAINT CHARLES RD STE A
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City | VILLA PARK
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State | IL
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Zip | 60181-2473
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Country | US
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Telephone | 630-339-3438
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Fax | 630-339-3434
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Authorized Official
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Title or Position | CEO
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Name | CARMEN URIBE CARDENAS
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Credential | DMD
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Telephone | 630-339-3438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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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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