Provider Demographics
NPI:1669620902
Name:ORAL & MAXILLOFACIAL SURGERY OF CHICAGO P.C.
Entity type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGERY OF CHICAGO P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUNJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-425-4301
Mailing Address - Street 1:6305 W 95TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2255
Mailing Address - Country:US
Mailing Address - Phone:708-425-4301
Mailing Address - Fax:888-334-0111
Practice Address - Street 1:60 ORLAND SQUARE DR STE 301
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6550
Practice Address - Country:US
Practice Address - Phone:708-349-4000
Practice Address - Fax:888-334-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190274471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty