Organization
THE CENTER FOR ORAL, MAXILLOFACIAL & IMPLANT SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HOLLY A. WALES (PRACTICE PRACTICE MANAGER)
(847) 869-1080
Entity
Organization
Contact information
Practice address
500 DAVIS ST 509, EVANSTON, IL 60201
(847) 869-9303
(847) 869-9323
Mailing address
500 DAVIS ST 509, EVANSTON, IL 60201
(847) 869-9303
(847) 869-9323
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
060.001866021.001194
IL
Other
Enumeration date
06/04/2008
Last updated
05/09/2025
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