OrganizationActive
Lakeside Oral & Implant Surgery Institute, PC
NPI 1679070189 · Oral and Maxillofacial Surgery Clinic/Center · Chicago, IL
Provider details
- NPI number
- 1679070189
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery Clinic/CenterAmbulatory Health Care Facilities
- Authorized official
- Alan Harvey, Oral & Maxillofacial Surgeon
- License
- 021002718 (IL)
Practice location
5758 S Maryland Ave # 4h
Chicago, IL 60637-1426
Phone: (773) 702-1865
Fax: (773) 834-3888
Mailing address
5841 S Maryland Ave # Mc9020
Chicago, IL 60637-1443
Registry dates
- Enumerated
- 2018-04-11
- Last updated
- 2018-04-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.