Healthcare Provider Details

I. General information

NPI: 1831812007
Provider Name (Legal Business Name): CRYSTAL CHOPP, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N 1ST AVE E STE 5
ELY MN
55731-1269
US

IV. Provider business mailing address

40 N 1ST AVE E STE 5
ELY MN
55731-1269
US

V. Phone/Fax

Practice location:
  • Phone: 218-365-3565
  • Fax: 218-365-3515
Mailing address:
  • Phone: 218-365-3565
  • Fax: 218-365-3515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE HAKALA
Title or Position: OFFICE MANAGER
Credential:
Phone: 218-365-3565