Healthcare Provider Details

I. General information

NPI: 1235055203
Provider Name (Legal Business Name): LAFONTE' CHERIE KRUSHALL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S PAULINA ST
CHICAGO IL
60612-7210
US

IV. Provider business mailing address

4 HIGH FOREST DR
BELLEVILLE IL
62226-4810
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7555
  • Fax:
Mailing address:
  • Phone: 217-816-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.037090
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: