MEDICARE: PLANO SMILES DENTAL CENTER, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019025575	IL

General Provider Information

NPI Number	:	1164443313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANO SMILES DENTAL CENTER, LTD

Provider Business Mailing Address
First Line	:	9 E MAIN ST
Second Line	:
City	:	PLANO
State	:	IL
Zip	:	60545-1521
Country	:	US
Telephone Number	:	630-552-8900
Fax Number	:	630-552-0889

Provider Business Practice Location Address
First Line	:	9 E MAIN ST
Second Line	:
City	:	PLANO
State	:	IL
Zip	:	60545-1521
Country	:	US
Telephone Number	:	630-552-8900
Fax Number	:	630-552-0889

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. JULIE A CONLIN
Credential	:	D.D.S.
Telephone Number	:	630-552-8900

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/12/2012

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