Organization
FULLSMILE FAMILY DENTIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDISON ALBERT ISHAYA (DENTIST)
(773) 235-0000
Entity
Organization
Contact information
Practice address
3939 W FULLERTON AVE, CHICAGO, IL 60647-2243
(773) 235-0000
(773) 235-0001
Mailing address
3939 W FULLERTON AVE, CHICAGO, IL 60647-2243
(773) 235-0000
(773) 235-0001
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019024678
IL
Other
Enumeration date
04/09/2008
Last updated
05/02/2008
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