14D2083862 CLIA NUMBER - CHICAGO SURGICAL SPECIALISTS

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Laboratory Demographics

CLIA Number: 14D2083862

Facility Name: CHICAGO SURGICAL SPECIALISTS

Facility Address:
22 S WASHINGTON AVE
PARK RIDGE, IL
ZIP 60068
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Facility Phone Number: 847 268-3910

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1235560178

Taxonomy: 1223S0112X - Dentist
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

CLIA Record

Field Name	Field Value
CLIA Number	14D2083862
LAB Type	Physician Office
Facility Name	CHICAGO SURGICAL SPECIALISTS
Street	22 S WASHINGTON AVE
City	PARK RIDGE
State	IL
ZIP	60068
Phone	847 268-3910
CertificateType	4
CertificateEffectiveDate	9/15/2022
CertificateExpirationDate	9/14/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024