Provider Demographics
NPI:1215123187
Name:SOUTHWEST ORAL SURGEONS,P.C.
Entity type:Organization
Organization Name:SOUTHWEST ORAL SURGEONS,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:FLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDSMPH
Authorized Official - Phone:708-425-4300
Mailing Address - Street 1:6305 W 95TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2255
Mailing Address - Country:US
Mailing Address - Phone:708-425-4300
Mailing Address - Fax:708-425-4310
Practice Address - Street 1:6305 W 95TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2255
Practice Address - Country:US
Practice Address - Phone:708-425-4300
Practice Address - Fax:708-425-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL669401Medicare PIN