Chicago Oral & Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

21-001074 Issued in IL

Legal business name

CHICAGO ORAL & MAXILLOFACIAL SURGERY

Practice address

676 N St. Clair Street
Suite 2280
Chicago, IL 60611-3197

Phone

(312) 926-2929

Fax

(312) 926-3595

NPI assigned

Jan 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Neil Bruce Hagen, DDSNPI 1376760363

Title

Owner

Phone

(312) 926-2929

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.

• Neil Bruce Hagen, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Chicago, IL
  • NPI 1376760363
  NPD (past) Authorized official
• Gregory Paul Thomas, DDS MD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Chicago, IL
  • NPI 1992883367
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242000000000",
    "number": "1366599748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N ST. CLAIR STREET",
            "address_2": "SUITE 2280",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113197",
            "telephone_number": "312-926-2929",
            "fax_number": "312-926-3595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N ST. CLAIR STREET",
            "address_2": "SUITE 2280",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113197",
            "telephone_number": "312-926-2929",
            "fax_number": "312-926-3595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2009-05-11",
        "status": "A",
        "authorized_official_last_name": "HAGEN",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-926-2929",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "21-001074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Chicago, IL
• Providers in Chicago, 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 May 11, 2009; 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.