Provider Demographics
NPI:1538394556
Name:SHAWNEE HILLS ORAL & MAXILLOFACIAL SURGERY, SC
Entity type:Organization
Organization Name:SHAWNEE HILLS ORAL & MAXILLOFACIAL SURGERY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-519-9363
Mailing Address - Street 1:2250 N REED STATION RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-8101
Mailing Address - Country:US
Mailing Address - Phone:618-519-9363
Mailing Address - Fax:618-519-9364
Practice Address - Street 1:2250 N REED STATION RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-8101
Practice Address - Country:US
Practice Address - Phone:618-519-9363
Practice Address - Fax:618-519-9364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery