| Oral & Maxillofacial Surgeons Of Lake County, P.c. | |
|
202 S Greenleaf St Suite A Gurnee IL 60031-3399 | |
| (847) 623-2830 | |
| (847) 623-1534 |
| Full Name | Oral & Maxillofacial Surgeons Of Lake County, P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Pathology |
| Location | 202 S Greenleaf St, Gurnee, Illinois |
| Authorized Official Name and Position | Fabian David Latocha (OWNER) |
| Authorized Official Contact | 8476232830 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral & Maxillofacial Surgeons Of Lake County, P.c. 202 S Greenleaf St Suite A Gurnee IL 60031-3399 Ph: (847) 623-2830 | Oral & Maxillofacial Surgeons Of Lake County, P.c. 202 S Greenleaf St Suite A Gurnee IL 60031-3399 Ph: (847) 623-2830 |
| NPI Number | 1023132859 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 04/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023132859 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | (Illinois) | Primary |
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