Kankakee Valley Oral Maxillofacial Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

KANKAKEE VALLEY ORAL MAXILLOFACIAL SURGERY PC

Practice address

31 Briarcliff Professional Ctr.
Bourbonnais, IL 60914

Phone

(815) 933-0990

Fax

(815) 933-0990

NPI assigned

Feb 11, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Ineke Catherine Basile

Title

Office Manager

Phone

(815) 933-0990

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Christopher Thomas Powell, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Bourbonnais, IL
  • NPI 1851389597
  NPD

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

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613001600000",
    "number": "1245822162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 BRIARCLIFF PROFESSIONAL CTR.",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-933-0990",
            "fax_number": "815-933-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 BRIARCLIFF PROFESSIONAL CTR.",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-933-0990",
            "fax_number": "815-933-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANKAKEE VALLEY ORAL MAXILLOFACIAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-11",
        "last_updated": "2021-02-11",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "BASILE",
        "authorized_official_first_name": "INEKE",
        "authorized_official_middle_name": "CATHERINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "815-933-0990",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Kalwinski
• Carly Kaminke, PA-C
• Brandi Kaye Kaner
• Kankakee Radiation Oncology LLC
• Kankakee Terrace Operator LLC
• Matthew Kaplan, DO
• Craig T Karvala, D.C.
• Katelyn Dircks
• Katelyn E. Dircks, LCSW, PLLC
• Jeffrey David Kazmierczak, PSY.D

• Oral and Maxillofacial Surgery (Dentist) in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; 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.