Organization
FIRST SMILES DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT GOLDMAN (PRESIDENT)
(847) 987-0322
Entity
Organization
Contact information
Practice address
278 MEMORIAL DR, SUITE B, CRYSTAL LAKE, IL 60014-6246
(815) 455-3110
Mailing address
278 MEMORIAL DR, SUITE B, CRYSTAL LAKE, IL 60014-6246
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
019027333
IL
Other
Enumeration date
12/26/2012
Last updated
12/26/2012
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