MEDICARE: MT PROSPECT SMILES P.C.

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	019025044	IL

General Provider Information

NPI Number	:	1922376011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT PROSPECT SMILES P.C.

Provider Business Mailing Address
First Line	:	724 E NORTHWEST HWY
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-3442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 E NORTHWEST HWY
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-3442
Country	:	US
Telephone Number	:	847-392-4270
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUMEET BAGAI
Credential	:	D.D.S
Telephone Number	:	847-392-4270

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	12/05/2011

Similar Medicare Providers

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Practice Location Address:

724 E NORTHWEST HWY
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1174531685 — VAN DRIELS MEDICAL SUPPORT WEAR CO
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1013022821 — JOHN D LANE, DDS, LTD
Practice Location Address:

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1689129637 — ATHENA DENTAL GROUP PC
Practice Location Address:

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1790877793 — MEGAN GITTINGS APRN
Practice Location Address:

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1184956625 — MRS. LINDSAY RENAE TUDOR MCCARTHY APRN
Practice Location Address:

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