Organization
ORAL AND MAXILLOFACIAL SURGERY AFFILIATES LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MICHAEL SISTO D.D.S. (PRESIDENT)
(847) 696-4848
Entity
Organization
Contact information
Practice address
111 S WASHINGTON ST., STE 101, PARK RIDGE, IL 60068-4203
(847) 696-4848
(847) 696-1609
Mailing address
111 S WASHINGTON AVE, STE 101, PARK RIDGE, IL 60068-4203
(847) 696-4848
(847) 696-1609
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
IL
Other
Enumeration date
04/23/2007
Last updated
08/22/2020
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