| Ottawa Smiles | |
|
110 W Center St Ottawa IL 61350-3557 | |
| (815) 434-6411 | |
| Not Available |
| Full Name | Ottawa Smiles |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 W Center St, Ottawa, 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 | Ottawa Smiles 110 W Center St Ottawa IL 61350-3557 Ph: (815) 434-6411 |
| NPI Number | 1497523559 |
|---|---|
| Provider Enumeration Date | 12/18/2023 |
| Last Update Date | 09/16/2026 |
| Certification Date | 09/16/2026 |
| Medicare PECOS PAC ID | 8123560463 |
|---|---|
| Medicare Enrollment ID | O20240603000823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497523559 | NPI | - | NPPES |
| Provider Name | Min Soo Kim |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1528449873 PECOS PAC ID: 9830631175 Enrollment ID: I20240603002142 |
| Provider Name | Dhaval Patel |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1750766499 PECOS PAC ID: 0749722080 Enrollment ID: I20250102000888 |
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