Provider Demographics
NPI:1417158320
Name:THE CENTRE FOR ORAL SURGERY IN JOLIET, INC.
Entity Type:Organization
Organization Name:THE CENTRE FOR ORAL SURGERY IN JOLIET, INC.
Other - Org Name:WILL COUNTY ORAL SURGERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BABIUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-254-1560
Mailing Address - Street 1:3209 FIDAY RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-0644
Mailing Address - Country:US
Mailing Address - Phone:815-254-1560
Mailing Address - Fax:815-254-1562
Practice Address - Street 1:3209 FIDAY RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-0644
Practice Address - Country:US
Practice Address - Phone:815-254-1560
Practice Address - Fax:815-254-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty