Organization
MGM19 INC
Active
Other names
McKnight Oral, Maxillofacial and Dental Implant Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW GREGORY MCKNIGHT DDS, MD (OWNER/PRESIDENT)
(630) 377-7077
Entity
Organization
Contact information
Practice address
605 COURTYARD DR, SAINT CHARLES, IL 60174-1463
(630) 377-7077
Mailing address
605 COURTYARD DR, SAINT CHARLES, IL 60174-1463
(630) 377-7077
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019.029613
DENTAL LICENSE
IL
01
—
021.002827
SPECIALIST LICENSE DENTISTRY
IL
01
—
036.144437
MEDICAL LICENSE
IL
01
—
1518250125
NPI
IL
Enumeration date
10/13/2019
Last updated
03/12/2024
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