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General NPI Number Information
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NPI Number | 1639291875
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Entity Type | Organization
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Legal Business Name | JOLIET ORAL SURGEONS
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1011 W JEFFERSON ST
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City | JOLIET
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State | IL
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Zip | 60435-6811
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Country | US
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Telephone | 815-727-7748
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Fax | 815-727-1787
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Provider Business Mailing Address
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Address Line | 1011 W JEFFERSON ST
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City | JOLIET
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State | IL
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Zip | 60435-6811
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Country | US
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Telephone | 815-727-7748
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Fax | 815-727-1787
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Authorized Official
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Title or Position | ORAL SURGEON D.D.S.
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Name | MR. GLENN SCHEIVE
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Credential |
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Telephone | 815-727-7748
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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 | 19015979
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License Number State | IL
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