Provider Demographics
NPI:1275142382
Name:DENTAL SMILES OF JOLIET
Entity Type:Organization
Organization Name:DENTAL SMILES OF JOLIET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-820-6487
Mailing Address - Street 1:2271 SABLE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5665
Mailing Address - Country:US
Mailing Address - Phone:213-820-6487
Mailing Address - Fax:
Practice Address - Street 1:2410 W JEFFERSON ST STE 108
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6451
Practice Address - Country:US
Practice Address - Phone:213-820-6484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental