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Organization
KANKAKEE VALLEY ORAL MAXILLOFACIAL SURGERY PC
Active
Organization
KANKAKEE VALLEY ORAL MAXILLOFACIAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. INEKE CATHERINE BASILE (OFFICE MANAGER)
(815) 933-0990
Entity
Organization
Contact information
Practice address
31 BRIARCLIFF PROFESSIONAL CTR., BOURBONNAIS, IL 60914
(815) 933-0990
(815) 933-0990
Mailing address
31 BRIARCLIFF PROFESSIONAL CTR., BOURBONNAIS, IL 60914
(815) 933-0990
(815) 933-0990
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
02/11/2021
Last updated
02/11/2021
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