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General NPI Number Information
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NPI Number | 1497894786
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Entity Type | Organization
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Legal Business Name | DRS. PEARLMAN, KLENETSKY & SIMCOX ORAL & MAXILLOFACIAL SURGERY, LTD.
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 1126 WESTGATE ST
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City | OAK PARK
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State | IL
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Zip | 60301-1008
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Country | US
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Telephone | 708-383-8851
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Fax | 708-383-6272
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Provider Business Mailing Address
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Address Line | 1126 WESTGATE ST
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City | OAK PARK
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State | IL
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Zip | 60301-1008
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Country | US
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Telephone | 708-383-8851
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Fax | 708-383-6272
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALLAN D. KLENETSKY
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Credential | D.M.D.
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Telephone | 708-383-8851
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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 | 21000970
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License Number State | IL
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