Organization
STAR SMILES ORTHODONTICS AND PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDRE JHAM DDS (ORTHODONTICS)
(773) 384-3500
Entity
Organization
Contact information
Practice address
3012 W FULLERTON AVE, CHICAGO, IL 60647-2940
(773) 384-3500
(773) 384-3963
Mailing address
3012 W FULLERTON AVE, CHICAGO, IL 60647-2940
(773) 384-3500
(773) 384-3963
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019028920
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019028920
—
IL
Enumeration date
11/26/2013
Last updated
11/26/2013
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