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NPI Code Detail

MEDICARE: BUFFALO GROVE ORAL & MAXILLOFACIAL SURGERY PC

MEDICARE: BUFFALO GROVE ORAL & MAXILLOFACIAL SURGERY PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)02100082IL
21223S0112XOral and Maxillofacial Surgery (Dentist)IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
180005430OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1679684369
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUFFALO GROVE ORAL & MAXILLOFACIAL SURGERY PC
Provider Business Mailing Address
First Line : 3325 N ARLINGTON HEIGHTS ROAD
Second Line : SUITE 600A
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004
Country : US
Telephone Number : 847-259-8883
Fax Number : 847-259-8891
Provider Business Practice Location Address
First Line : 3325 N ARLINGTON HEIGHTS ROAD
Second Line : SUITE 600A
City : ARLINGTON HEIGHTS
State : IL
Zip : 60004
Country : US
Telephone Number : 847-259-8883
Fax Number : 847-259-8891
Authorized Official
Title or Position : ORAL & MAXILLOFACIAL SURGEON PRES
Name : DR. HERBERT M KANTER
Credential : DDS
Telephone Number : 847-259-8883
Provider Enumeration Date : 08/31/2006
Last Update Date : 08/22/2020

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Directions to “BUFFALO GROVE ORAL & MAXILLOFACIAL SURGERY PC ” Practice Location

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