# ILLINOIS ORAL AND MAXILLOFACIAL SURGERY

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

## Provider details

- **NPI number:** 1780456616
- **Authorized official:** MICHAEL BARBICK DMD MD (OWNER)
- **Authorized official phone:** (813) 755-9100

## Contact information

- **Practice address:** 426 S 3RD ST, GENEVA, IL 60134-2854
- **Practice address phone:** (630) 232-9090
- **Practice address fax:** (630) 232-9094
- **Mailing address:** 15170 N FLORIDA AVE, TAMPA, FL 33613-1229
- **Mailing address phone:** (813) 755-9100

## Taxonomy

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

## Other

- **Enumeration date:** 10/24/2023
- **Last updated:** 10/25/2023