| NPI | 1518191295 |
|---|---|
| Doing Business As | ORAL SURGERY CENTER |
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER THOMAS POWELL President 815-464-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021001750) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 021001487) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: 021002201) | |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2009-05-08 |