Organization
COUNTRYWIDE SMILES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BOGDAN MIHAI TARAN D.D.S. (PRESIDENT)
(773) 733-6344
Entity
Organization
Contact information
Practice address
110 S STATE ST, ANNAWAN, IL 61234-9716
(309) 935-6126
Mailing address
501 DODGE ST, KEWANEE, IL 61443-3258
(773) 733-6344
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019027941
IL
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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