# SOUTHERN ILLINOIS ORAL & MAXILLOFACIAL SURGERY, LTD.

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

## Provider details

- **NPI number:** 1538180617
- **Authorized official:** DR. MICHAEL R. HESTERBERG D.M.D. (PRESIDENT)
- **Authorized official phone:** (618) 233-8080

## Contact information

- **Practice address:** 2900 FRANK SCOTT PKWY W, SUITE 960, BELLEVILLE, IL 62223-5000
- **Practice address phone:** (618) 233-8080
- **Practice address fax:** (618) 233-1192
- **Mailing address:** 2900 FRANK SCOTT PKWY W, SUITE 960, BELLEVILLE, IL 62223-5000
- **Mailing address phone:** (618) 233-8080
- **Mailing address fax:** (618) 233-1192

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 021-001364 | IL | Yes |

## Other

- **Enumeration date:** 07/22/2006
- **Last updated:** 11/24/2014