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General NPI Number Information
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NPI Number | 1710267638
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Entity Type | Organization
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Legal Business Name | KL FAMILY DENTAL
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 1N121 COUNTY FARM RD
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City | WINFIELD
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State | IL
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Zip | 60190-2019
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Country | US
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Telephone | 630-653-7706
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Fax |
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Provider Business Mailing Address
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Address Line | 1N121 COUNTY FARM RD
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City | WINFIELD
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State | IL
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Zip | 60190-2019
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Country | US
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Telephone | 630-653-7706
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KARYN M KRUEGER-SWADE
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Credential | D.D.S.
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Telephone | 630-653-7706
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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 | 019022967
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019023214
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License Number State | IL
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