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General NPI Number Information
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NPI Number | 1891641148
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Entity Type | Organization
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Legal Business Name | WISDOM TEETH AND BEYOND ORAL SURGERY
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 4 N DEER POINT RD STE 1008
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City | HAINESVILLE
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State | IL
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Zip | 60030-3814
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Country | US
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Telephone | 847-388-6098
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Fax | 847-388-6099
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Provider Business Mailing Address
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Address Line | 4 N DEER POINT RD STE 1008
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City | HAINESVILLE
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State | IL
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Zip | 60030-3814
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Country | US
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Telephone | 847-388-6098
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Fax | 847-388-6099
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEJANDRO VALLADARES
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Credential | DDS
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Telephone | 978-855-6659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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