Provider Demographics
NPI:1427478429
Name:ANTIOCH ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES P.C.
Entity type:Organization
Organization Name:ANTIOCH ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:CHOUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-650-7777
Mailing Address - Street 1:21880 N. HARBOR RD.
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:708-650-7777
Mailing Address - Fax:847-395-7956
Practice Address - Street 1:21880 N. HARBOR RD.
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:708-650-7777
Practice Address - Fax:847-395-7956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty