Organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
UIC Maxillofacial Prosthetics Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAURENCE APPEL (CHIEF FINANCIAL OFFICER)
(312) 996-3620
Entity
Organization
Contact information
Practice address
811 S PAULINA ST, 118 DENT, MC 588, CHICAGO, IL 60612-4353
(312) 996-6933
(312) 355-4173
Mailing address
1740 W TAYLOR ST # MC693, CHICAGO, IL 60612-7232
(312) 996-3620
(312) 996-0850
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
07/24/2009
Last updated
05/19/2025
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