FACIAL COSMETIC & RECONSTRUCTIVE SURGERY, SC (NPI# 1417123076) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417123076 |
| Entity Type | Organization |
| Organization Name | FACIAL COSMETIC & RECONSTRUCTIVE SURGERY, SC |
| Practice Address |
11825 N Knoxville Ave Dunlap IL 61525-8842 |
| Practice Telephone | 3092438980 |
| Practice Fax Number | 3092438983 |
| Mailing Telephone | 3092438980 |
| Mailing Fax Number | 3092438983 |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2008-05-05 |
| Authorized Official Name | WENDY CHRISTINE MORRISON (OFFICE MANAGER) |
| Authorized Official Telephone | 3092438980 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
019025195 | IL | Ambulatory Health Care Facilities |
| Street Address |
11825 N KNOXVILLE AVE |
| City | DUNLAP |
| State | IL |
| Zip Code | 61525-8842 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427116854 | Maple Shade Dental Group | Dentist | 11825 N Knoxville Ave, Dunlap, IL 61525 | 2006-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821512674 | Kids Thrive Therapy, LLC | Speech-Language Pathologist | 11221 N Blackstone Court, Dunlap, IL 61525 | 2017-08-02 |
| 1679857536 | Manish Patel | Pharmacist | 1700 W. Hickory Grove Rd, Apt 3-209, Dunlap, IL 61525 | 2011-10-10 |
| 1134302839 | Thomas Rickey | Pharmacist | 10424 N Osage Ct, Dunlap, IL 61525 | 2007-12-17 |
| 1407213796 | Tommy Bohannan | Durable Medical Equipment & Medical Supplies | 11417 N Boulder Creek Ct, Dunlap, IL 61525-1500 | 2016-01-19 |
| 1225499080 | Bohannan Medical Dist., LLC | Durable Medical Equipment & Medical Supplies | 11417 N Boulder Creek Ct, Dunlap, IL 61525-1500 | 2016-03-08 |
| 1437770872 | Laurie Michelle Kaplan | Dietitian, Registered | 12603 N. Feucht Rd, Dunlap, IL 61525-6152 | 2020-04-27 |
| 1255859575 | Kay Lynn Trilikis | Speech-Language Pathologist | 11230 N Greenview Ln, Dunlap, IL 61525-7542 | 2017-09-07 |
| 1891944864 | Naby Nature's Hand Inc | Massage Therapist | 307 S 4th St, Dunlap, IL 61525-8025 | 2008-09-15 |
| 1891820312 | Mapleshade Vision Center Inc. | Optometrist | 11825 State Route 40, Suite 101, Dunlap, IL 61525-8842 | 2007-02-23 |
| 1265887210 | Jackson Sleep Centers Pllc | Dentist | 11825 State Route 40, Suite 100, Dunlap, IL 61525-8842 | 2016-04-27 |
| Find all providers in zip 61525 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427605351 | The Bloom Oral Surgery, P.C. | Clinic/Center | 219 N Hammes Ave Ste 1, Joliet, IL 60435-8145 | 2019-08-26 |
| 1528543121 | Joms LLC | Clinic/Center | 10 Martin Ave Ste 164, Naperville, IL 60540-6563 | 2018-09-28 |
| 1750861209 | Winterset Dental Care PC | Clinic/Center | 8559 S Pulaski Rd Ste 103, Chicago, IL 60652-3643 | 2018-08-15 |
| 1679070189 | Lakeside Oral & Implant Surgery Institute, PC | Clinic/Center | 5758 S Maryland Ave # 4h, Chicago, IL 60637-1426 | 2018-04-11 |
| 1962753210 | Millennium Surgical, Inc | Clinic/Center | 5978 S Archer Ave, Chicago, IL 60638-2817 | 2012-09-26 |
| 1851551642 | Alan Andreas Harvey | Clinic/Center | 2500 Ridge Ave Ste 302, Evanston, IL 60201-2477 | 2008-06-15 |
| 1881808053 | Oral and Maxillofacial Surgery Specalists Ltd. | Clinic/Center | 4035 Morsay Dr., Rockford, IL 61107-4871 | 2007-05-09 |
| 1962599605 | Affiliated Oral & Maxillofacial Surgeons Ltd | Clinic/Center | 3438 N Old Arlington Heights Rd, Arlington Heights, IL 60004 | 2006-10-06 |
| 1437703113 | Shady Oak Dental LLC Oral and Maxillofacial Surgeons of Northwest Il | Clinic/Center | 208 N Walnut Ave, Forreston, IL 61030-9330 | 2019-07-30 |
| 1598250995 | Periodontics and Implant Dentistry LLC | Clinic/Center | 8559 S Pulaski Rd, Chicago, IL 60652-3643 | 2018-06-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.