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MAXILLOFACIAL AND FACIAL AESTHETIC SURGERY NPI 1992978852


NPI Information

NPI: 1992978852
Provider Name: MAXILLOFACIAL AND FACIAL AESTHETIC SURGERY
Classification: Oral & Maxillofacial Surgery - 204E00000X
Entity Type: Organization

CLIA Number: 14D1088902

Address:
426 S 3RD ST
GENEVA, IL
ZIP 60134
Phone: (630) 232-9090
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MAXILLOFACIAL AND FACIAL AESTHETIC SURGERY is an oral maxillofacial surgery in Geneva, IL. The provider is oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. MAXILLOFACIAL AND FACIAL AESTHETIC SURGERY NPI is 1992978852. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

426 S 3RD ST
GENEVA, IL
ZIP 60134-708
Phone: (630) 232-9090
Fax: (630) 232-9094

The provider's authorized official is Kevin Ray Haddle .
The authorized official title is Physician Owner and has the following contact phone number (630) 232-9090.

The CLIA number assigned to this NPI record is 14D1088902 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/10/2008 and was last updated on 4/10/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryILLINOISNo
2204E00000XOral & Maxillofacial SurgeryILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1H98071MEDICARE UPINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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