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Organization
MAXILLOFACIAL AND FACIAL AESTHETIC SURGERY
Active
Organization
MAXILLOFACIAL AND FACIAL AESTHETIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN RAY HADDLE MD, DDS (PHYSICIAN OWNER)
(630) 232-9090
Entity
Organization
Contact information
Practice address
426 S 3RD ST, GENEVA, IL 60134-2708
(630) 232-9090
(630) 232-9094
Mailing address
426 S 3RD ST, GENEVA, IL 60134-2708
(630) 232-9090
(630) 232-9094
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
IL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
IL
Other
Enumeration date
04/10/2008
Last updated
04/10/2008
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