Healthcare Provider Details

I. General information

NPI: 1497808588
Provider Name (Legal Business Name): ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 1ST ST SUITE 103
HINSDALE IL
60521-4249
US

IV. Provider business mailing address

105 E 1ST ST SUITE 103
HINSDALE IL
60521-4249
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-8070
  • Fax: 630-850-7537
Mailing address:
  • Phone: 630-789-8070
  • Fax: 630-850-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROL BONAMI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 630-789-8070