Healthcare Provider Details

I. General information

NPI: 1841122389
Provider Name (Legal Business Name): CRANIAL FACIAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E ERIE ST STE 406
CHICAGO IL
60611-5955
US

IV. Provider business mailing address

1340 MANTLEBROOK DR
DESOTO TX
75115-2966
US

V. Phone/Fax

Practice location:
  • Phone: 972-679-4828
  • Fax:
Mailing address:
  • Phone: 972-679-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: SHANIQUA LEGINGTON
Title or Position: ADMIN
Credential:
Phone: 972-679-4828