Provider Demographics
NPI:1891328027
Name:GREAT SMILES DENTAL PC
Entity Type:Organization
Organization Name:GREAT SMILES DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KAIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RABADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-715-0805
Mailing Address - Street 1:13075 S 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2466
Mailing Address - Country:US
Mailing Address - Phone:708-715-0805
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:815-744-4443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental