Healthcare Provider Details

I. General information

NPI: 1487740932
Provider Name (Legal Business Name): CARLLA DUSTER FRANKLIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLLA EVELYN DUSTER DDS

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 THEODORE STREET
CREST HILL IL
60432
US

IV. Provider business mailing address

957 S MANNHEIM RD STE 1-S
WESTCHESTER IL
60154-2544
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-1700
  • Fax:
Mailing address:
  • Phone: 630-330-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019022586
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: