Oral and Maxillofacial Surgery Affiliates LTD.

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

Legal business name

ORAL AND MAXILLOFACIAL SURGERY AFFILIATES LTD.

Practice address

111 S Washington St.
Ste 101
Park Ridge, IL 60068-4203

Phone

(847) 696-4848

Fax

(847) 696-1609

NPI assigned

Apr 23, 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

Dr. John Michael Sisto, D.D.S.NPI 1336365642

Title

President

Phone

(847) 696-4848

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, and the practitioner matching its NPPES authorized official.

• John Michael Sisto, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Park Ridge, IL
  • NPI 1336365642
  Authorized official Same address or phone

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982822912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S WASHINGTON AVE",
            "address_2": "STE 101",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684203",
            "telephone_number": "847-696-4848",
            "fax_number": "847-696-1609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S WASHINGTON ST.",
            "address_2": "STE 101",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684203",
            "telephone_number": "847-696-4848",
            "fax_number": "847-696-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AND MAXILLOFACIAL SURGERY AFFILIATES LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SISTO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-696-4848",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Pathology Dentistry in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Oral and Maxillofacial Pathology Dentistry 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.