Provider Demographics
NPI:1669880258
Name:ANGEL SMILE DENTAL CARE, PC
Entity type:Organization
Organization Name:ANGEL SMILE DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VASYL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARANOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-621-2287
Mailing Address - Street 1:2352 S ELMHURST RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-5805
Mailing Address - Country:US
Mailing Address - Phone:773-968-9864
Mailing Address - Fax:847-979-8370
Practice Address - Street 1:2352 S ELMHURST RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-5805
Practice Address - Country:US
Practice Address - Phone:773-968-9864
Practice Address - Fax:847-979-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty