Organization
BROWN ARCHER DENTAL PC
Active
Other names
Smile Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHALIL TAKLA (PRESIDENT)
(773) 788-9090
Entity
Organization
Contact information
Practice address
4893 S ARCHER AVE, CHICAGO, IL 60632
(773) 788-9090
Mailing address
4893 S ARCHER AVE, CHICAGO, IL 60632-3621
(773) 788-9090
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019025135
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306916465
—
IL
Enumeration date
08/29/2017
Last updated
07/21/2022
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