Healthcare Provider Details

I. General information

NPI: 1114911872
Provider Name (Legal Business Name): ASSOCIATES FOR ORAL MAXILLOFACIAL AND IMPLANT SURGERY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N RIDGE AVE
MT PROSPECT IL
60056-2428
US

IV. Provider business mailing address

10 N RIDGE AVE
MT PROSPECT IL
60056-2428
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-7080
  • Fax: 847-255-6931
Mailing address:
  • Phone: 847-255-7080
  • Fax: 847-255-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DENNIS J SPINAZZE
Title or Position: ORAL MAXILLOFACIAL SURGEON
Credential: DDS
Phone: 847-255-7080