MEDICARE: SMILE WITH US PC

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	019027941	IL

General Provider Information

NPI Number	:	1386077436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE WITH US PC

Provider Business Mailing Address
First Line	:	501 DODGE ST
Second Line	:
City	:	KEWANEE
State	:	IL
Zip	:	61443-3258
Country	:	US
Telephone Number	:	773-733-6344
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 TENNEY ST
Second Line	:
City	:	KEWANEE
State	:	IL
Zip	:	61443-3746
Country	:	US
Telephone Number	:	773-733-6344
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BOGDAN MIHAI TARAN
Credential	:
Telephone Number	:	773-733-6344

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	08/13/2013

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