Provider Demographics
NPI:1750686820
Name:7011 W ARCHER AVE
Entity Type:Organization
Organization Name:7011 W ARCHER AVE
Other - Org Name:SMILE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-364-8900
Mailing Address - Street 1:7011 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2201
Mailing Address - Country:US
Mailing Address - Phone:773-788-9090
Mailing Address - Fax:
Practice Address - Street 1:7011 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2201
Practice Address - Country:US
Practice Address - Phone:773-788-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190251351223G0001X
IL0190274031223G0001X
IL0190250771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty