Joliet Oral Surgeons

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

19015979 Issued in IL

Legal business name

JOLIET ORAL SURGEONS

Practice address

1011 W Jefferson St
Joliet, IL 60435-6811

Phone

(815) 727-7748

Fax

(815) 727-1787

NPI assigned

Apr 6, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Glenn Scheive

Title

Oral Surgeon D.D.S.

Phone

(815) 727-7748

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639291875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 W JEFFERSON ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356811",
            "telephone_number": "815-727-7748",
            "fax_number": "815-727-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 W JEFFERSON ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356811",
            "telephone_number": "815-727-7748",
            "fax_number": "815-727-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOLIET ORAL SURGEONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHEIVE",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "ORAL SURGEON  D.D.S.",
        "authorized_official_telephone_number": "815-727-7748",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "19015979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Joliet, IL
• Providers in Joliet, 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 Aug 22, 2020; 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.