Organization
SCHOOL HOUSE DENTAL SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERROLD W. SMITH D.D.S. (PRESIDENT)
(773) 881-3911
Entity
Organization
Contact information
Practice address
2000 W 95TH ST, CHICAGO, IL 60643-1116
(773) 881-3911
(773) 881-4058
Mailing address
2000 W 95TH ST, CHICAGO, IL 60643-1116
(773) 881-3911
(773) 881-4058
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019016584
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101412
—
IL
Enumeration date
07/22/2008
Last updated
07/22/2008
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