Provider Demographics
NPI:1598830325
Name:PAUL A SMULSON DDS ORAL SURGERY LTD
Entity Type:Organization
Organization Name:PAUL A SMULSON DDS ORAL SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-251-0077
Mailing Address - Street 1:5400 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1272
Mailing Address - Country:US
Mailing Address - Phone:773-763-6836
Mailing Address - Fax:773-775-4431
Practice Address - Street 1:5400 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1272
Practice Address - Country:US
Practice Address - Phone:773-763-6836
Practice Address - Fax:773-775-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty