Organization
EVASKUS AND HERZOG, LTD
Active
Other names
Oral Surgery Associates
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PIETRI (INSURANCE COORDINATOR)
(773) 761-7171
Entity
Organization
Contact information
Practice address
2440 W PETERSON AVE, CHICAGO, IL 60659-4113
(773) 761-7171
(773) 761-6714
Mailing address
2440 W PETERSON AVE, CHICAGO, IL 60659-4113
(773) 761-7171
(773) 761-6714
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
060003037
IL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
09/19/2006
Last updated
12/09/2019
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