| Organization Name: | FANTASTIC SMILES LTD. |
| NPI Number: | 1104254630 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EWA KOSER (PRESIDENT) |
| Mailing Address: | 250 W Kensington Rd Suite 2a Mt Prospect |
| State: | IL US |
| Postal Code: | 600561293 |
| Phone Number: | 8475775464 |
| Fax Number: | 8475775474 |
| NPI Enumeration Date: | 10/18/2013 |
| NPI Last Update Date: | 10/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 019-024294 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |