Organization
IMPLANT DENTAL ARTS
Active
Other names
Chicago Smile Design
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER MICHAEL TOMASELLI D.D.S. (PRACTICE OWNER)
(312) 664-2100
Entity
Organization
Contact information
Practice address
437 W NORTH AVE, CHICAGO, IL 60610-1420
(312) 664-2100
Mailing address
437 W NORTH AVE, CHICAGO, IL 60610-1420
(312) 664-2100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019027304
IL
1223G0001X
General Practice Dentistry
Primary
BT 0632403
IL
Other
Enumeration date
02/12/2010
Last updated
02/12/2010
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