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General NPI Number Information
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NPI Number | 1780456616
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Entity Type | Organization
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Legal Business Name | ILLINOIS ORAL AND MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 426 S 3RD ST
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City | GENEVA
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State | IL
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Zip | 60134-2854
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Country | US
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Telephone | 630-232-9090
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Fax | 630-232-9094
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Provider Business Mailing Address
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Address Line | 15170 N FLORIDA AVE
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City | TAMPA
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State | FL
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Zip | 33613-1229
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Country | US
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Telephone | 813-755-9100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL BARBICK
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Credential | DMD MD
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Telephone | 813-755-9100
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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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