NPIMap

Organization Active NPI

Oral and Maxillofacial Surgery Affiliates LTD.

  • Oral and Maxillofacial Pathology Dentistry
  • Park Ridge, IL
National Provider Identifier
1982822912
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
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
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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.
Title
President
Phone
(847) 696-4848

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0106X IL Primary

Addresses

Primary practice location

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

Mailing address

111 S Washington Ave
Ste 101
Park Ridge, IL 60068-4203
Phone (847) 696-4848

National Provider Directory

National Provider Directory

Locations

350 S Northwest Hwy
Ste 118
Park Ridge, IL 60068
Phone (847) 696-4848

111 S Washington Ave
Ste 101
Park Ridge, IL 60068
Phone (847) 696-4848

NPI Registry JSON

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": []
}

Other providers in Park Ridge, IL

Sources for this page

  • 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.