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Organization

LAKESIDE ORAL & IMPLANT SURGERY INSTITUTE, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ALAN HARVEY DMD (ORAL & MAXILLOFACIAL SURGEON)
(773) 702-1865
Entity
Organization

Contact information

Practice address
5758 S MARYLAND AVE # 4H, CHICAGO, IL 60637-1426
(773) 702-1865
(773) 834-3888
Mailing address
5841 S MARYLAND AVE # MC9020, CHICAGO, IL 60637-1443
(773) 702-1865
(773) 834-3888

Taxonomy

Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
021002718
IL

Other

Enumeration date
04/11/2018
Last updated
04/11/2018
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