MEDICARE: ATTAINABLE 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	019030727	IL

General Provider Information

NPI Number	:	1639677040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATTAINABLE SMILES DENTAL

Provider Business Mailing Address
First Line	:	1124 BLOOMINGDALE RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3498
Country	:	US
Telephone Number	:	630-260-9898
Fax Number	:

Provider Business Practice Location Address
First Line	:	1124 BLOOMINGDALE RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3498
Country	:	US
Telephone Number	:	630-260-9898
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TOMMY JOHN CASTILLO SAGADRACA
Credential	:	DMD
Telephone Number	:	630-260-9898

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/31/2018

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Directions to “ATTAINABLE SMILES DENTAL ” Practice Location

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