Provider Demographics
NPI:1265740575
Name:CONFIDENT SMILE DENTAL PC
Entity type:Organization
Organization Name:CONFIDENT SMILE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:IKRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-975-9048
Mailing Address - Street 1:360 CHRYSLER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008
Mailing Address - Country:US
Mailing Address - Phone:815-975-9048
Mailing Address - Fax:815-975-9056
Practice Address - Street 1:360 CHRYSLER DRIVE
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-6001
Practice Address - Country:US
Practice Address - Phone:815-975-9048
Practice Address - Fax:815-975-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty