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General NPI Number Information
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NPI Number | 1639805138
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Entity Type | Organization
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Legal Business Name | HEATHER HRUSKOCY DMD PC
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 1089 CONWAY RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-2617
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Country | US
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Telephone | 847-436-3882
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Fax |
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Provider Business Mailing Address
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Address Line | 1089 CONWAY RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-2617
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Country | US
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Telephone | 847-436-3882
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | HEATHER HRUSKOCY
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Credential | DMD
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Telephone | 847-436-3882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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