NPIMap

Organization Active NPI

The Center for Oral, Maxillofacial & Implant Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Evanston, IL
National Provider Identifier
1205095387
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
060.001866021.001194 Issued in IL
Legal business name
THE CENTER FOR ORAL, MAXILLOFACIAL & IMPLANT SURGERY
Practice address
500 Davis St 509
Evanston, IL 60201
Phone
(847) 869-9303
Fax
(847) 869-9323
NPI assigned
Jun 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Holly A. Wales
Title
Practice Practice Manager
Phone
(847) 869-1080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 060.001866021.001194 IL Primary

Addresses

Primary practice location

500 Davis St 509
Evanston, IL 60201

Mailing address

500 Davis St 509
Evanston, IL 60201
Phone (847) 869-9303

National Provider Directory

National Provider Directory

Locations

500 Davis St
Ste 509
Evanston, IL 60201
Phone (847) 869-9303

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1205095387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 DAVIS ST 509",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60201",
            "telephone_number": "847-869-9303",
            "fax_number": "847-869-9323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 DAVIS ST 509",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60201",
            "telephone_number": "847-869-9303",
            "fax_number": "847-869-9323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER FOR ORAL, MAXILLOFACIAL & IMPLANT SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-04",
        "last_updated": "2025-05-09",
        "status": "A",
        "authorized_official_last_name": "WALES",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRACTICE PRACTICE MANAGER",
        "authorized_official_telephone_number": "847-869-1080",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "060.001866021.001194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.