# NORTH SUBURBAN ORAL AND MAXILLOFACIAL SURGERY LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477664332
- **Authorized official:** DR. RICHARD P. MARTINO DDS (PRESIDENT)
- **Authorized official phone:** (847) 234-3390

## Contact information

- **Practice address:** 900 N WESTMORELAND RD, SUITE 208, LAKE FOREST, IL 60045-1674
- **Practice address phone:** (847) 234-3390
- **Practice address fax:** (847) 234-3391
- **Mailing address:** 900 N WESTMORELAND RD, SUITE 208, LAKE FOREST, IL 60045-1674
- **Mailing address phone:** (847) 234-3390
- **Mailing address fax:** (847) 234-3391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | 021000537 | IL | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 02/10/2009