Provider Demographics
NPI:1770850653
Name:TREASURED SMILES GENERAL DENTISTRY, LLC
Entity type:Organization
Organization Name:TREASURED SMILES GENERAL DENTISTRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-426-0016
Mailing Address - Street 1:10325 W. LINCOLN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:815-426-0016
Mailing Address - Fax:815-426-0015
Practice Address - Street 1:10325 W. LINCOLN HIGHWAY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423
Practice Address - Country:US
Practice Address - Phone:815-426-0016
Practice Address - Fax:815-426-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2480003181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty