Healthcare Provider Details

I. General information

NPI: 1013028398
Provider Name (Legal Business Name): MEJ & ASSOCIATES ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 CARLEMONT DR SUITE #F
CRYSTAL LAKE IL
60014-1833
US

IV. Provider business mailing address

1500 CARLEMONT DR SUITE #F
CRYSTAL LAKE IL
60014-1833
US

V. Phone/Fax

Practice location:
  • Phone: 815-356-3977
  • Fax:
Mailing address:
  • Phone: 815-356-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number21002105
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL EDWIN JONES
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 815-356-3977