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General NPI Number Information
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NPI Number | 1801290556
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Entity Type | Organization
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Legal Business Name | SMILEDENTIST, P.C.
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 3403 W. LAWRENCE AVE SUITE 202
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City | CHICAGO
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State | IL
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Zip | 60625
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Country | US
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Telephone | 773-539-1003
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Fax | 773-539-1036
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Provider Business Mailing Address
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Address Line | 3403 W LAWRENCE AVE SUITE 202
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City | CHICAGO
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State | IL
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Zip | 60625-5165
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Country | US
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Telephone | 773-539-1003
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Fax | 773-539-1036
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SANG U. WOO
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Credential | D.D.S
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Telephone | 773-988-8971
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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 | 019021646
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License Number State | IL
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