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General NPI Number Information
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NPI Number | 1962837047
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Entity Type | Organization
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Legal Business Name | NAPERVILLE ORAL SURGERY, LLC
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 605 S WASHINGTON ST
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City | NAPERVILLE
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State | IL
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Zip | 60540-6643
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Country | US
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Telephone | 630-708-6637
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Fax |
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Provider Business Mailing Address
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Address Line | 605 SOUTH WASHINGON STREET
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City | NAPERVILLE
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State | IL
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Zip | 60540
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Country | US
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Telephone | 630-708-6637
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA FOXSON
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Credential | D.D.S., M.S.
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Telephone | 630-708-6637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019029110
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License Number State | IL
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Taxonomy #2
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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 | 021002503
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License Number State | IL
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