Organization
ORAL FACIAL SURGERY INSTITUTE OF ILLINOIS P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT E GRAHAM MHA, FACMPE, FAADOM (ADMINISTRATOR)
(314) 413-6043
Entity
Organization
Contact information
Practice address
10200 WEST MAIN STREET, BELLEVILLE, IL 62223
(618) 397-2464
(618) 398-4450
Mailing address
10200 WEST MAIN STREET, BELLEVILLE, IL 62223
(618) 397-2464
(618) 398-4450
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
07/16/2014
Last updated
09/08/2025
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