MEDICARE: CRYSTAL SMILES DENTAL

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1184518235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL SMILES DENTAL

Provider Business Mailing Address
First Line	:	2520 LINCOLN HWY STE F
Second Line	:
City	:	OLYMPIA FIELDS
State	:	IL
Zip	:	60461-1961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 LINCOLN HWY STE F
Second Line	:
City	:	OLYMPIA FIELDS
State	:	IL
Zip	:	60461-1961
Country	:	US
Telephone Number	:	708-307-4908
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SIMON A TADROS
Credential	:	DMD
Telephone Number	:	708-307-4908

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	06/04/2025

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Directions to “CRYSTAL SMILES DENTAL ” Practice Location

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