Provider Demographics
NPI:1225100597
Name:JOLIET SMILE WORLD DENTAL CENTER, INC.
Entity Type:Organization
Organization Name:JOLIET SMILE WORLD DENTAL CENTER, INC.
Other - Org Name:JOLIET SMILE WORLD, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-741-4155
Mailing Address - Street 1:3555 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-4708
Mailing Address - Country:US
Mailing Address - Phone:815-741-4155
Mailing Address - Fax:815-741-4535
Practice Address - Street 1:3555 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-4708
Practice Address - Country:US
Practice Address - Phone:815-741-4155
Practice Address - Fax:815-741-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty