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NPI Code Detail

MEDICARE: PAUL A SMULSON DDS ORAL SURGERY LTD

MEDICARE: PAUL A SMULSON DDS ORAL SURGERY 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
11223S0112XOral and Maxillofacial Surgery (Dentist)IL

General Provider Information

NPI Number : 1598830325
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAUL A SMULSON DDS ORAL SURGERY LTD
Provider Business Mailing Address
First Line : 5400 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-1272
Country : US
Telephone Number : 773-763-6836
Fax Number : 773-775-4431
Provider Business Practice Location Address
First Line : 5400 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-1272
Country : US
Telephone Number : 773-763-6836
Fax Number : 773-775-4431
Authorized Official
Title or Position : PRESIDENT
Name : PAUL A SMULSON
Credential :
Telephone Number : 847-251-0077
Provider Enumeration Date : 11/21/2006
Last Update Date : 08/22/2020

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