# ORAL AND MAXILLOFACIAL SURGERY AFFILIATES LTD.

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

## Provider details

- **NPI number:** 1982822912
- **Authorized official:** DR. JOHN MICHAEL SISTO D.D.S. (PRESIDENT)
- **Authorized official phone:** (847) 696-4848

## Contact information

- **Practice address:** 111 S WASHINGTON ST., STE 101, PARK RIDGE, IL 60068-4203
- **Practice address phone:** (847) 696-4848
- **Practice address fax:** (847) 696-1609
- **Mailing address:** 111 S WASHINGTON AVE, STE 101, PARK RIDGE, IL 60068-4203
- **Mailing address phone:** (847) 696-4848
- **Mailing address fax:** (847) 696-1609

## Taxonomy

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

## Other

- **Enumeration date:** 04/23/2007
- **Last updated:** 08/22/2020