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General NPI Number Information
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NPI Number | 1891328027
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Entity Type | Organization
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Legal Business Name | GREAT SMILES DENTAL PC
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 2410 W JEFFERSON ST STE 108
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City | JOLIET
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State | IL
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Zip | 60435-6451
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Country | US
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Telephone | 815-744-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 13075 S 80TH AVE
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-2466
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Country | US
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Telephone | 708-715-0805
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | KAIS RABADI
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Credential |
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Telephone | 708-715-0805
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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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