Organization
FANTASTIC SMILES LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EWA KOSER DDS (PRESIDENT)
(847) 577-5464
Entity
Organization
Contact information
Practice address
250 W KENSINGTON RD, SUITE 2A, MT PROSPECT, IL 60056-1293
(847) 577-5464
(847) 577-5474
Mailing address
250 W KENSINGTON RD, SUITE 2A, MT PROSPECT, IL 60056-1293
(847) 577-5464
(847) 577-5474
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019-024294
IL
Other
Enumeration date
10/18/2013
Last updated
10/18/2013
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