LAKESIDE ORAL & IMPLANT SURGERY INSTITUTE, PC (NPI# 1679070189) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679070189 |
| Entity Type | Organization |
| Organization Name | LAKESIDE ORAL & IMPLANT SURGERY INSTITUTE, PC |
| Practice Address |
5758 S Maryland Ave # 4h Chicago IL 60637-1426 |
| Mailing Address |
5841 S Maryland Ave # Mc9020 Chicago IL 60637-1443 |
| Practice Telephone | 7737021865 |
| Practice Fax Number | 7738343888 |
| Mailing Telephone | 7737021865 |
| Mailing Fax Number | 7738343888 |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2018-04-11 |
| Authorized Official Name | ALAN HARVEY (ORAL & MAXILLOFACIAL SURGEON) |
| Authorized Official Telephone | 7737021865 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
021002718 | IL | Ambulatory Health Care Facilities |
| Street Address |
5758 S MARYLAND AVE # 4H |
| City | CHICAGO |
| State | IL |
| Zip Code | 60637-1426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386263234 | Pooja Ramnani | Pharmacist | 5841 S Maryland Ace, Chicago, IL 60637 | 2020-04-10 |
| 1780220079 | Tara Coleman | Non-emergency Medical Transport (VAN) | 808 E. 63rd Street, Suite 135, Chicago, IL 60637 | 2019-11-21 |
| 1366003501 | Valerie Silas | Case Management | 6330 S King Drive, Chicago, IL 60637 | 2019-06-27 |
| 1205391620 | Derek Joseph Fiedler | Anesthesiology | University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 | 2019-02-11 |
| 1821573072 | Ugochinyere Ohaja | Registered Nurse | 5656 South Maryland Avenue, Chicago, IL 60637 | 2018-10-03 |
| 1053899138 | Won Hee Oh | Physician Assistant | 5841 S. Maryland Ave., Mc5040, Chicago, IL 60637 | 2018-08-01 |
| 1558854695 | Rasidat Adeduntan | Internal Medicine | 5841 S. Maryland Avenue, [7082], Chicago, IL 60637 | 2018-06-13 |
| 1194235283 | Melissa Ann Arangoa | Registered Nurse | 5841 S. Maryland Ave, Mc 1083, Chicago, IL 60637 | 2017-10-03 |
| 1558880633 | Marni Harris | Optometrist | 5841 S Maryland Ave # S421, Chicago, IL 60637 | 2017-09-11 |
| 1992235105 | Vidya Mahavadi | Pediatrics | 5841 S. Maryland Avenue, Mail Code 8016, Chicago, IL 60637 | 2017-06-20 |
| Find all providers in zip 60637 | ||||
| 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 |
|---|---|---|---|---|
| 1750861209 | Winterset Dental Care PC | Clinic/Center | 8559 S Pulaski Rd Ste 103, Chicago, IL 60652-3643 | 2018-08-15 |
| 1962753210 | Millennium Surgical, Inc | Clinic/Center | 5978 S Archer Ave, Chicago, IL 60638-2817 | 2012-09-26 |
| 1598250995 | Periodontics and Implant Dentistry LLC | Clinic/Center | 8559 S Pulaski Rd, Chicago, IL 60652-3643 | 2018-06-27 |
| 1558643734 | Northwestern Oral & Maxillofacial Surgeons PC | Clinic/Center | 201 E Huron St, Suite 12-100, Chicago, IL 60611-3197 | 2011-09-14 |
| 1053600791 | George S. Panos D.d.s. Ltd. | Clinic/Center | 5470 W Madison St, Chicago, IL 60644-4031 | 2011-04-04 |
| 1609956903 | Rush Presbyterian-st Lukes Med Ctr | Clinic/Center | 1725 W Harrison St, Suite 425, Pob 1, Chicago, IL 60612-3841 | 2006-10-17 |
| 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 |
| 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 |
| 1205288982 | Lakeside Oral & Facial Surgery Institute | Clinic/Center | 2500 Ridge Ave, Suite 302, Evanston, IL 60201-2455 | 2016-07-06 |
| 1760850291 | Kloberdanz Oral Surgery and Dental Implants P.C. | Clinic/Center | 2580 Foxfield Rd Ste 100, St Charles, IL 60174-1411 | 2015-09-15 |
| 1811379142 | Rock River Oral Surgery & Dental Implant Center LLC | Clinic/Center | 973 Featherstone Rd, Suite 102, Rockford, IL 61107-5912 | 2015-06-23 |
| 1124257571 | John Brunetti, Dmd, Ltd. | Clinic/Center | 1 E Phillip Rd, Suite 101, Vernon Hills, IL 60061-1858 | 2009-07-07 |
| 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.