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General NPI Number Information
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NPI Number | 1013506922
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Entity Type | Organization
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Legal Business Name | PARTNERS IN ORAL SURGERY AND IMPLANTS PLLC
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 10241 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1279
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Country | US
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Telephone | 815-464-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 10241 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1279
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Country | US
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Telephone | 815-464-6500
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAURA BONOMO
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Credential |
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Telephone | 815-464-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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