Provider Demographics
NPI:1497894786
Name:DRS. PEARLMAN, KLENETSKY & SIMCOX ORAL & MAXILLOFACIAL SURGERY, LTD.
Entity Type:Organization
Organization Name:DRS. PEARLMAN, KLENETSKY & SIMCOX ORAL & MAXILLOFACIAL SURGERY, LTD.
Other - Org Name:DRS. PEARLMAN, KLENETSKY & SIMCOX ORAL & MAXILLOFACIAL SURGERY, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLENETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-383-8851
Mailing Address - Street 1:1126 WESTGATE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1008
Mailing Address - Country:US
Mailing Address - Phone:708-383-8851
Mailing Address - Fax:708-383-6272
Practice Address - Street 1:1126 WESTGATE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1008
Practice Address - Country:US
Practice Address - Phone:708-383-8851
Practice Address - Fax:708-383-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL210009701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215932OtherPTAN
ILT37128Medicare UPIN
IL525310Medicare ID - Type Unspecified