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General NPI Number Information
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NPI Number | 1124490875
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Entity Type | Organization
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Legal Business Name | HOWARD L. CRYSTAL, D.D.S., P.C.
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 929 RIDGE RD.
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City | WILMETTE
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State | IL
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Zip | 60091-1559
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Country | US
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Telephone | 847-906-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 929 RIDGE RD.
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City | WILMETTE
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State | IL
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Zip | 60091-1559
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Country | US
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Telephone | 847-906-3480
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HOWARD LAWRENCE CRYSTAL
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Credential | D.D.S.
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Telephone | 773-370-6307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019016617
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License Number State | IL
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