Organization
MAXILLOFACIAL AND FACIAL AESTHETIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN RAY HADDLE MD, DDS (PHYSICIAN OWNER)
(630) 232-9090
Entity
Organization
Contact information
Practice address
426 S 3RD ST, GENEVA, IL 60134-2708
(630) 232-9090
(630) 232-9094
Mailing address
426 S 3RD ST, GENEVA, IL 60134-2708
(630) 232-9090
(630) 232-9094
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
IL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
IL
Other
Enumeration date
04/10/2008
Last updated
04/10/2008
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