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General NPI Number Information
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NPI Number | 1932465804
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Entity Type | Organization
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Legal Business Name | SMILE SENSE
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 4941 N KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60625-5009
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Country | US
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Telephone | 773-661-0668
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Fax | 773-661-0396
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Provider Business Mailing Address
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Address Line | 4941 N KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60625-5009
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Country | US
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Telephone | 773-661-0668
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Fax | 773-661-0396
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ISLAM NAEM
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Credential | DDS
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Telephone | 313-506-0795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019028042
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License Number State | IL
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