Organization Name: | HOWARD L. CRYSTAL, D.D.S., P.C. |
NPI Number: | 1124490875 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HOWARD LAWRENCE CRYSTAL (PRESIDENT) |
Mailing Address: | 929 Ridge Rd. Wilmette |
State: | IL US |
Postal Code: | 600911559 |
Phone Number: | 8479063480 |
Fax Number: | |
NPI Enumeration Date: | 10/21/2015 |
NPI Last Update Date: | 10/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 019016617 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |