Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 01925282 | IL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5250 015 | WI |
NPI | 1033127238 |
---|---|
Provider Name | Adam Ozment |
First Address | Crystal Lake, IL 60012 |
Second Address | Crystal Lake, IL 60012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 07/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U81648 | (02) | WI |