Lakeside Oral & Facial Surgery Institute

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

021002718 Issued in IL

Legal business name

LAKESIDE ORAL & FACIAL SURGERY INSTITUTE

Practice address

2500 Ridge Ave
Suite 302
Evanston, IL 60201-2455

Phone

(847) 328-8899

Fax

(847) 563-1350

NPI assigned

Jul 6, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Alan Harvey, DMDNPI 1851551642

Title

Oral & Maxillofacial Surgeon

Phone

(847) 328-8899

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Alan Andreas Harvey, D.M.D.

  • Oral and Maxillofacial Surgery Clinic/Center
  • Evanston, IL
  • NPI 1851551642
  NPD Authorized official
• Joseph E Canzona, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Evanston, IL
  • NPI 1265411276
  NPD (past)

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524096000000",
    "number": "1205288982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 RIDGE AVE",
            "address_2": "SUITE 302",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602012455",
            "telephone_number": "847-328-8899",
            "fax_number": "847-563-1350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 RIDGE AVE",
            "address_2": "SUITE 302",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602012455",
            "telephone_number": "847-328-8899",
            "fax_number": "847-563-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE ORAL & FACIAL SURGERY INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-06",
        "last_updated": "2018-04-19",
        "status": "A",
        "authorized_official_last_name": "HARVEY",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "ORAL & MAXILLOFACIAL SURGEON",
        "authorized_official_telephone_number": "847-328-8899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021002718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanne Barbara Lagattolla, LCPC
• Lake Shore Gastroenterology
• Lakeside Digestion PLLC
• Lakeside Eye Care & Eye Wear Emporium, LTD.
• Lakeside Medical, Inc.
• Khadija Lakhtir
• Archana Lal-Tabak, MD
• Lamarr Lemee Dental Corp
• Carla F. Lamarr, D.D.S
• Joni A Lamb, LCSW

• Oral and Maxillofacial Surgery Clinic/Center in Evanston, IL
• Providers in Evanston, IL by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; 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.