Organization
EDISON PARK SMILES,LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARREN DWAIN SIMPSON DDS (OWNER)
(708) 369-4076
Entity
Organization
Contact information
Practice address
6426 N NORTHWEST HWY, CHICAGO, IL 60631-1450
(773) 631-5200
Mailing address
6426 N NORTHWEST HWY, CHICAGO, IL 60631-1450
(773) 631-5200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019025308
IL
Other
Enumeration date
11/04/2016
Last updated
11/04/2016
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