Healthcare Provider Details

I. General information

NPI: 1245240043
Provider Name (Legal Business Name): CHRIS A KROLACK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 MAIN ST SUITE 1
CRETE IL
60417-1911
US

IV. Provider business mailing address

1014 MAIN ST P.O. BOX 38
CRETE IL
60417-1911
US

V. Phone/Fax

Practice location:
  • Phone: 708-672-8115
  • Fax: 708-672-6324
Mailing address:
  • Phone: 708-672-8115
  • Fax: 708-672-6324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: