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Organization
SOUTHWEST SMILING DENTAL P.C.
Active
Organization
SOUTHWEST SMILING DENTAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIANJUN HAO (OWNER)
(773) 941-1010
Entity
Organization
Contact information
Practice address
11141 S KEDZIE AVE, CHICAGO, IL 60655-2329
(773) 779-1606
Mailing address
836 S MILLER ST, CHICAGO, IL 60607-4207
(773) 941-1010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
Other
Enumeration date
05/14/2019
Last updated
05/14/2019
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