Provider Demographics
NPI:1639291875
Name:JOLIET ORAL SURGEONS
Entity Type:Organization
Organization Name:JOLIET ORAL SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON D.D.S.
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEIVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-727-7748
Mailing Address - Street 1:1011 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6811
Mailing Address - Country:US
Mailing Address - Phone:815-727-7748
Mailing Address - Fax:815-727-1787
Practice Address - Street 1:1011 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6811
Practice Address - Country:US
Practice Address - Phone:815-727-7748
Practice Address - Fax:815-727-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190159791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty