Individual
IAN CHARLES MCCOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
019029867
IL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
021003032
IL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
2901022524
MI
Other
Enumeration date
04/03/2014
Last updated
05/25/2022
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