Provider Demographics
NPI:1619242906
Name:DENTAL SMILES
Entity Type:Organization
Organization Name:DENTAL SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMAAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-744-4443
Mailing Address - Street 1:2410 W JEFFERSON ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6449
Mailing Address - Country:US
Mailing Address - Phone:815-744-4443
Mailing Address - Fax:815-744-4460
Practice Address - Street 1:2410 W JEFFERSON ST
Practice Address - Street 2:SUITE 108
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6449
Practice Address - Country:US
Practice Address - Phone:815-744-4443
Practice Address - Fax:815-744-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190262231223G0001X
IL0190286591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty