| Star Smiles Orthodontics And Pediatric Dentistry | |
|
3012 W Fullerton Ave Chicago IL 60647-2940 | |
| (773) 384-3500 | |
| (773) 384-3963 |
| Full Name | Star Smiles Orthodontics And Pediatric Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3012 W Fullerton Ave, Chicago, Illinois |
| Authorized Official Name and Position | Andre Jham (ORTHODONTICS) |
| Authorized Official Contact | 7733843500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Star Smiles Orthodontics And Pediatric Dentistry 3012 W Fullerton Ave Chicago IL 60647-2940 Ph: (773) 384-3500 | Star Smiles Orthodontics And Pediatric Dentistry 3012 W Fullerton Ave Chicago IL 60647-2940 Ph: (773) 384-3500 |
| NPI Number | 1013347160 |
|---|---|
| Provider Enumeration Date | 11/26/2013 |
| Last Update Date | 11/26/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013347160 | NPI | - | NPPES |
| 019028920 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019028920 (Illinois) | Primary |
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