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Organization
NORTH SUBURBAN ORAL AND MAXILLOFACIAL SURGERY LTD
Active
Organization
NORTH SUBURBAN ORAL AND MAXILLOFACIAL SURGERY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD P. MARTINO DDS (PRESIDENT)
(847) 234-3390
Entity
Organization
Contact information
Practice address
900 N WESTMORELAND RD, SUITE 208, LAKE FOREST, IL 60045-1674
(847) 234-3390
(847) 234-3391
Mailing address
900 N WESTMORELAND RD, SUITE 208, LAKE FOREST, IL 60045-1674
(847) 234-3390
(847) 234-3391
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
021000537
IL
Other
Enumeration date
08/31/2006
Last updated
02/10/2009
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