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General NPI Number Information
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NPI Number | 1881350981
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Entity Type | Organization
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Legal Business Name | SWEET TOOTH ODONTOLOGA LLC
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 4732 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60632-4114
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Country | US
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Telephone | 773-376-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 200 W PARKVIEW DR
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City | ADDISON
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State | IL
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Zip | 60101-3727
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Country | US
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Telephone | 630-532-0207
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA VILLAFANE
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Credential | DMD
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Telephone | 630-532-0207
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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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