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Organization
SMILES OF ELGIN P.C
Active
Organization
SMILES OF ELGIN P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PRASAD GONAVARUM DDS (OWNER)
(847) 695-3368
Entity
Organization
Contact information
Practice address
860 SUMMIT ST, SUITE 134, ELGIN, IL 60120-5145
(847) 695-3368
(847) 695-3351
Mailing address
860 SUMMIT ST, SUITE 134, ELGIN, IL 60120-5145
(847) 695-3368
(847) 695-3351
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019019439
IL
Other
Enumeration date
12/28/2011
Last updated
12/28/2011
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