MEDICARE: ASSOCIATES FOR ORAL MAXILLOFACIAL AND IMPLANT SURGERY LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)		IL

General Provider Information

NPI Number	:	1114911872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES FOR ORAL MAXILLOFACIAL AND IMPLANT SURGERY LTD

Provider Business Mailing Address
First Line	:	10 N RIDGE AVE
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-2428
Country	:	US
Telephone Number	:	847-255-7080
Fax Number	:	847-255-6931

Provider Business Practice Location Address
First Line	:	10 N RIDGE AVE
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-2428
Country	:	US
Telephone Number	:	847-255-7080
Fax Number	:	847-255-6931

Authorized Official
Title or Position	:	ORAL MAXILLOFACIAL SURGEON
Name	:	DENNIS J SPINAZZE
Credential	:	DDS
Telephone Number	:	847-255-7080

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	08/22/2020

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