Crystal Lake Oral Maxillofacial Surgery Ltd in Crystal Lake - Oral And Maxillofacial Surgery
Crystal Lake Oral Maxillofacial Surgery Ltd - NPI 1730197468
Crystal Lake Oral Maxillofacial Surgery Ltd is a Oral And Maxillofacial Surgery in Crystal Lake, Illinois. Crystal Lake Oral Maxillofacial Surgery Ltd practices all healthcare services and medical treatments related to Oral And Maxillofacial Surgery. The NPI Number for Crystal Lake Oral Maxillofacial Surgery Ltd is 1730197468. The last update date is 2010-06-03.
Crystal Lake Oral Maxillofacial Surgery Ltd's current location address is 690 N Il Route 31, Crystal Lake, Illinois. You can contact this provider via phone number 8154595600 and fax number 8154595615. The mailing address for Crystal Lake Oral Maxillofacial Surgery Ltd is 690 N Il Route 31, Crystal Lake, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Crystal Lake Oral Maxillofacial Surgery Ltd |
|---|---|
| Address | 690 N Il Route 31, Crystal Lake, Illinois |
| Phone Number | 8154595600 |
| Fax Number | 8154595615 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | VICE-PRESI |
|---|---|
| Authorized Official Name | Bruksch E Kurt |
| Credentials | D.D.S. |
| Telephone Number | 8154595600 |
NPI Number Detail
| NPI Number | 1730197468 |
|---|---|
| Provider Enumeration Date | 2006-08-05 |
| Last Updated Date | 2010-06-03 |
Provider Mailing Address Detail
| Address | 690 N Il Route 31 |
|---|---|
| City | Crystal Lake |
| State | Illinois (IL) |
| Post Code | 600123790 |
| Phone Number | 8154595600 |
| Fax Number | 8154595615 |
Provider's Primary Taxonomy Detail
| Speciality | Oral And Maxillofacial Surgery |
|---|---|
| Taxonomy | 1223S0112X |
| Licence No | 19018137 |
|
Definition: The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 19025282 | ID | -- | |
| 19016621 | IL | -- | |
| 19018137 | IL | -- | |
| 19013457 | IL | -- | |
| 1700865441 | NPI # DR. JOHN RICHARD |
Post Comment/ Review Below
What is the unique identification code assigned to Crystal Lake Oral Maxillofacial Surgery Ltd by the Centers for Medicare & Medicaid Services?
The Crystal Lake Oral Maxillofacial Surgery Ltd has been issued the NPI (National Provider Identifier) 1730197468. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete physical address where Crystal Lake Oral Maxillofacial Surgery Ltd is located?
The Crystal Lake Oral Maxillofacial Surgery Ltd is situated at the following address: 690 N Il Route 31, Crystal Lake, IL, 600123790.
What is Crystal Lake Oral Maxillofacial Surgery Ltd's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Crystal Lake Oral Maxillofacial Surgery Ltd is Oral And Maxillofacial Surgery, and the taxonomy classification code that categorizes this area of expertise is 1223S0112X.
On what date did the Centers for Medicare & Medicaid Services issue the 1730197468 to Crystal Lake Oral Maxillofacial Surgery Ltd?
The Crystal Lake Oral Maxillofacial Surgery Ltd received its 1730197468 assignment from the Centers for Medicare & Medicaid Services on 2006-08-05.
As of what date were the details related to Crystal Lake Oral Maxillofacial Surgery Ltd most recently updated or revised?
The information pertaining to Crystal Lake Oral Maxillofacial Surgery Ltd, including its address, specialty, and other relevant details, was last updated or revised on 2010-06-03.