Healthcare Provider Details

I. General information

NPI: 1801804182
Provider Name (Legal Business Name): MIDLAND ORAL SURGERY AND IMPLANT CENTERS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 159TH ST
TINLEY PARK IL
60477-1492
US

IV. Provider business mailing address

7625 159TH ST
TINLEY PARK IL
60477-1492
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-4770
  • Fax: 708-429-9685
Mailing address:
  • Phone: 708-429-4770
  • Fax: 708-429-9685

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: DR. EDWARD L KASPER
Title or Position: SENIOR PARTNER
Credential: DDS
Phone: 708-429-4770