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General NPI Number Information
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NPI Number | 1891189189
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Entity Type | Organization
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Legal Business Name | SMART MOUTH DENTAL P.C.
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 7105 JANES AVE
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City | WOODRIDGE
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State | IL
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Zip | 60517-2321
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Country | US
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Telephone | 630-963-7766
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Fax | 630-963-7850
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Provider Business Mailing Address
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Address Line | 7105 JANES AVE
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City | WOODRIDGE
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State | IL
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Zip | 60517-2321
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Country | US
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Telephone | 630-963-7766
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHLEEN WEGNER BARTO
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Credential | D.D.S.
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Telephone | 630-963-7766
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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 | 19026697
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License Number State | IL
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