Central Illinois Oral and Maxiofacial Surgery, PC
NPI #1841449329 in Springfield, Illinois
Provider Information
- NPI Number
- 1841449329
- Entity Type
- Organization
- Organization Name
- Central Illinois Oral and Maxiofacial Surgery, PC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- CENTRAL ILLINOIS ORAL AND MAXIOFACIAL SURGERY, PC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Sep 9, 2008
- Last Updated
- Sep 11, 2008
Practice Location
- Address
- 2633 CHATHAM RD STE A
- City
- Springfield
- State
- Illinois
- ZIP Code
- 62704-4185
- Phone
- (217) 698-8777
Authorized Official
- Name
- PAM HARDIEK
- Title
- INSURANCE/CREDENTIALING
- Phone
- (217) 540-5100
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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