| Peskin Oral Surgery, Ltd. | |
|
4711 Golf Rd Suite 408 Skokie IL 60076-1224 | |
| (847) 676-4590 | |
| (847) 676-4695 |
| Full Name | Peskin Oral Surgery, Ltd. |
|---|---|
| Speciality | Dentist |
| Location | 4711 Golf Rd, Skokie, Illinois |
| Authorized Official Name and Position | Kenneth Howard Peskin (PRESIDENT/OWNER-ORAL SURGEON) |
| Authorized Official Contact | 8476764590 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peskin Oral Surgery, Ltd. 4711 Golf Rd Suite 408 Skokie IL 60076-1224 Ph: (847) 676-4590 | Peskin Oral Surgery, Ltd. 4711 Golf Rd Suite 408 Skokie IL 60076-1224 Ph: (847) 676-4590 |
| NPI Number | 1649286287 |
|---|---|
| Provider Enumeration Date | 08/01/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3870775364 |
|---|---|
| Medicare Enrollment ID | O20110304000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649286287 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (Illinois) | Primary |
| Provider Name | Kenneth H Peskin |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1619983244 PECOS PAC ID: 2860674355 Enrollment ID: I20110304000024 |
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