| Ottawa Smiles | |
|
4260 Westbrook Dr Ste 105 Aurora IL 60504-8136 | |
| (314) 503-2066 | |
| Not Available |
| Full Name | Ottawa Smiles |
|---|---|
| Speciality | Dentist |
| Location | 4260 Westbrook Dr Ste 105, Aurora, Illinois |
| Authorized Official Name and Position | Min Kim (OWNER) |
| Authorized Official Contact | 3145032066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ottawa Smiles 4260 Westbrook Dr Ste 105 Aurora IL 60504-8136 Ph: () - | Ottawa Smiles 4260 Westbrook Dr Ste 105 Aurora IL 60504-8136 Ph: (314) 503-2066 |
| NPI Number | 1497523559 |
|---|---|
| Provider Enumeration Date | 12/18/2023 |
| Last Update Date | 04/24/2024 |
| Medicare PECOS PAC ID | 8123560463 |
|---|---|
| Medicare Enrollment ID | O20240603000823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497523559 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Min Soo Kim |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1528449873 PECOS PAC ID: 9830631175 Enrollment ID: I20240603002142 |
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