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Organization
ORAL AND MAXILLOFACIAL SURGERY AFFILIATES LTD.
Active
Organization
ORAL AND MAXILLOFACIAL SURGERY AFFILIATES LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MICHAEL SISTO D.D.S. (PRESIDENT)
(847) 696-4848
Entity
Organization
Contact information
Practice address
111 S WASHINGTON ST., STE 101, PARK RIDGE, IL 60068-4203
(847) 696-4848
(847) 696-1609
Mailing address
111 S WASHINGTON AVE, STE 101, PARK RIDGE, IL 60068-4203
(847) 696-4848
(847) 696-1609
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
IL
Other
Enumeration date
04/23/2007
Last updated
08/22/2020
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