Healthcare Provider Details

I. General information

NPI: 1962599605
Provider Name (Legal Business Name): AFFILIATED ORAL & MAXILLOFACIAL SURGEONS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 N OLD ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60004
US

IV. Provider business mailing address

3438 N OLD ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60004
US

V. Phone/Fax

Practice location:
  • Phone: 847-392-6700
  • Fax: 847-392-6707
Mailing address:
  • Phone: 847-392-6700
  • Fax: 847-392-6707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. STUART DESSNER
Title or Position: OMF SURGEON PRESIDENT
Credential: DMD
Phone: 847-392-6700