MEDICARE: SMILES PAR EXCELLENCE 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	261QD0000X	Dental Clinic/Center		IL

General Provider Information

NPI Number	:	1477534329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILES PAR EXCELLENCE PC

Provider Business Mailing Address
First Line	:	9830 RIDGELAND AVE
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2667
Country	:	US
Telephone Number	:	708-636-6424
Fax Number	:	708-636-6424

Provider Business Practice Location Address
First Line	:	9830 RIDGELAND AVE
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2667
Country	:	US
Telephone Number	:	708-636-6424
Fax Number	:	708-636-6424

Authorized Official
Title or Position	:	DDS
Name	:	HANY YOUSSEF MOHAMED
Credential	:	DDS
Telephone Number	:	708-636-6424

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	08/22/2020

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Directions to “SMILES PAR EXCELLENCE PC ” Practice Location

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