Organization
CHICAGO ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEIL BRUCE HAGEN DDS (OWNER)
(312) 926-2929
Entity
Organization
Contact information
Practice address
676 N ST. CLAIR STREET, SUITE 2280, CHICAGO, IL 60611-3197
(312) 926-2929
(312) 926-3595
Mailing address
676 N ST. CLAIR STREET, SUITE 2280, CHICAGO, IL 60611-3197
(312) 926-2929
(312) 926-3595
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
21-001074
IL
Other
Enumeration date
01/05/2007
Last updated
05/11/2009
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