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General NPI Number Information
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NPI Number | 1437403367
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Entity Type | Organization
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Legal Business Name | CARLSON, CASTOR & HAUF, P.C.
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 10775 N IL ROUTE 47
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City | HUNTLEY
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State | IL
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Zip | 60142-9770
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Country | US
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Telephone | 847-669-4771
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Fax |
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Provider Business Mailing Address
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Address Line | 10775 NORTH ROUTE 47
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City | HUNTLEY
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State | IL
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Zip | 60142
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Country | US
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Telephone | 847-669-4771
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Fax |
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Authorized Official
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Title or Position | CO-PRESIDENT
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Name | DR. PATRICIA CASTOR
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Credential | D.D.S
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Telephone | 312-203-5608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019027039
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License Number State | IL
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