Provider Demographics
NPI:1093991721
Name:STITH ORAL AND MAXILLOFACIAL SURGERY, LTD.
Entity Type:Organization
Organization Name:STITH ORAL AND MAXILLOFACIAL SURGERY, LTD.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:STITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-208-6700
Mailing Address - Street 1:1131 RANDALL CT
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3911
Mailing Address - Country:US
Mailing Address - Phone:630-208-6700
Mailing Address - Fax:630-208-6709
Practice Address - Street 1:1131 RANDALL CT
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3911
Practice Address - Country:US
Practice Address - Phone:630-208-6700
Practice Address - Fax:630-208-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017449204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL792720Medicare PIN