NPIMap

Organization Active NPI

Facial Cosmetic & Reconstructive Surgery, SC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Dunlap, IL
National Provider Identifier
1417123076
Registry record updated May 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
License
019025195 Issued in IL
Legal business name
FACIAL COSMETIC & RECONSTRUCTIVE SURGERY, SC
Practice address
11825 N Knoxville Ave
Dunlap, IL 61525-8842
Phone
(309) 243-8980
Fax
(309) 243-8983
NPI assigned
May 5, 2008
Last updated
May 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2008

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

Authorized official

Name
Wendy Christine Morrison
Title
Office Manager
Phone
(309) 243-8980

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 019025195 IL Primary

Addresses

Primary practice location

11825 N Knoxville Ave
Dunlap, IL 61525-8842

Mailing address

11825 N Knoxville Ave
Dunlap, IL 61525-8842
Phone (309) 243-8980

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1417123076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11825 N KNOXVILLE AVE",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615258842",
            "telephone_number": "309-243-8980",
            "fax_number": "309-243-8983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11825 N KNOXVILLE AVE",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615258842",
            "telephone_number": "309-243-8980",
            "fax_number": "309-243-8983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACIAL COSMETIC & RECONSTRUCTIVE SURGERY, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-05",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "MORRISON",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "309-243-8980"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019025195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunlap, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; 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.