Organization
ROBERT C. BOSACK, DDS & ASSOCIATES, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT C. BOSACK DDS (OWNER/ORAL SURGEON)
(708) 460-9100
Entity
Organization
Contact information
Practice address
16011 108TH AVE STE A, ORLAND PARK, IL 60467-8787
(708) 460-9100
(708) 460-7919
Mailing address
16011 108TH AVE STE A, ORLAND PARK, IL 60467-8787
(708) 460-9100
(708) 460-7919
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021.001152
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376550558
—
IL
05
—
1518250125
—
IL
Enumeration date
08/23/2017
Last updated
07/21/2022
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