Provider Demographics
NPI:1235557109
Name:EVERYONE'S FAMILY DENTAL ST. CHARLES LLC
Entity Type:Organization
Organization Name:EVERYONE'S FAMILY DENTAL ST. CHARLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUBRAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-844-5283
Mailing Address - Street 1:1400 LINCOLN HWY
Mailing Address - Street 2:UNIT B
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3580
Mailing Address - Country:US
Mailing Address - Phone:773-844-5283
Mailing Address - Fax:
Practice Address - Street 1:1604 VISA DR
Practice Address - Street 2:UNIT #3
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-2195
Practice Address - Country:US
Practice Address - Phone:773-844-5283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty