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General NPI Number Information
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NPI Number | 1659216760
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Entity Type | Organization
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Legal Business Name | ORAL AND FACIAL SURGERY OF THE NORTHSHORE
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Dates
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Enumeration Date | 04/23/2026
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Last Update Date | 04/23/2026
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Provider Practice Location Address
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Address Line | 4200 DEMPSTER ST
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City | SKOKIE
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State | IL
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Zip | 60076-2008
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Country | US
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Telephone | 224-623-0709
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 DEMPSTER ST
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City | SKOKIE
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State | IL
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Zip | 60076-2008
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Country | US
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Telephone | 224-623-0709
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Fax |
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Authorized Official
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Title or Position | ORAL AND MAXILLOFACIAL SURGEON
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Name | DR. STEPHEN MARTIN
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Credential | DMD
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Telephone | 404-788-8520
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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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