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General NPI Number Information
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NPI Number | 1811490055
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Entity Type | Organization
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Legal Business Name | ALL PERFECT SMILES OF FRANKFORT PC
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 11137 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-7428
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Country | US
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Telephone | 815-277-2840
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Fax | 779-254-2130
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Provider Business Mailing Address
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Address Line | 11137 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-7428
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Country | US
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Telephone | 815-277-2840
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Fax | 779-254-2130
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | OSCAR GEOVANNI GONZALEZ
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Credential | DDS, MBA
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Telephone | 219-465-8627
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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 | 019021104
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License Number State | IL
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