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General NPI Number Information
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NPI Number | 1497808588
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Entity Type | Organization
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Legal Business Name | ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, P.C.
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 105 E 1ST ST SUITE 103
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City | HINSDALE
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State | IL
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Zip | 60521-4249
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Country | US
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Telephone | 630-789-8070
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Fax | 630-850-7537
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Provider Business Mailing Address
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Address Line | 105 E 1ST ST SUITE 103
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City | HINSDALE
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State | IL
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Zip | 60521-4249
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Country | US
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Telephone | 630-789-8070
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Fax | 630-850-7537
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | CAROL BONAMI
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Credential |
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Telephone | 630-789-8070
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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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