Lakeside Oral & Facial Surgery Institute

NPI #1205288982 in Evanston, Illinois

Provider Information

NPI Number: 1205288982
Entity Type: Organization
Organization Name: Lakeside Oral & Facial Surgery Institute
Primary Specialty: Clinic/Center - Oral and Maxillofacial Surgery
Enumeration Date: Jul 6, 2016
Last Updated: Apr 19, 2018

Practice Location

Address: 2500 RIDGE AVE
Address 2: SUITE 302
City: Evanston
State: Illinois
ZIP Code: 60201-2455
Phone: (847) 328-8899

Authorized Official

Name: DR. ALAN HARVEY, DMD
Title: ORAL & MAXILLOFACIAL SURGEON
Phone: (847) 328-8899

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery	261QS0112X	Primary

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