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General NPI Number Information
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NPI Number | 1710462130
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Entity Type | Organization
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Legal Business Name | THE CENTRE FOR ORAL SURGERY IN JOLIET, INC.
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 3209 FIDAY RD
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City | JOLIET
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State | IL
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Zip | 60431-0644
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Country | US
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Telephone | 952-653-2565
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Fax | 952-653-2540
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Provider Business Mailing Address
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Address Line | 3209 FIDAY RD
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City | JOLIET
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State | IL
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Zip | 60431-0644
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Country | US
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Telephone | 952-653-2565
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Fax | 952-653-2540
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Authorized Official
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Title or Position | CEO
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Name | JAMES JOHN BABIUK
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Credential | ORAL SURGEON
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Telephone | 815-254-1560
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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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