Provider Demographics
NPI:1013028398
Name:MEJ & ASSOCIATES ENTERPRISES LLC
Entity Type:Organization
Organization Name:MEJ & ASSOCIATES ENTERPRISES LLC
Other - Org Name:FOX RIVER ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-356-3977
Mailing Address - Street 1:1500 CARLEMONT DR
Mailing Address - Street 2:SUITE #F
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1833
Mailing Address - Country:US
Mailing Address - Phone:815-356-3977
Mailing Address - Fax:
Practice Address - Street 1:1500 CARLEMONT DR
Practice Address - Street 2:SUITE #F
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1833
Practice Address - Country:US
Practice Address - Phone:815-356-3977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL210021051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty