# ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS OF PEORIA, LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Associated Oral Surgeons
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154357291
- **Authorized official:** ROBYN WOLFE (PRACTICE LEADER)
- **Authorized official phone:** (309) 682-1249

## Contact information

- **Practice address:** 5720 N KNOXVILLE AVE, PEORIA, IL 61614-4331
- **Practice address phone:** (309) 682-1213
- **Practice address fax:** (309) 682-5386
- **Mailing address:** 5720 N KNOXVILLE AVE, PEORIA, IL 61614-4331
- **Mailing address phone:** (309) 682-1213
- **Mailing address fax:** (309) 682-5386

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 019023700 | IL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 019024407 | IL | Yes |

## Other

- **Enumeration date:** 06/23/2006
- **Last updated:** 11/05/2024