CRYSTAL LAKE ORAL MAXILLOFACIAL SURGERY LTD (NPI# 1730197468) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730197468 |
| Entity Type | Organization |
| Organization Name | CRYSTAL LAKE ORAL MAXILLOFACIAL SURGERY LTD |
| Practice Address |
690 N Il Route 31 Crystal Lake IL 60012-3790 |
| Practice Telephone | 8154595600 |
| Practice Fax Number | 8154595615 |
| Mailing Telephone | 8154595600 |
| Mailing Fax Number | 8154595615 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2010-06-03 |
| Authorized Official Name | DR. KURT E BRUKSCH (VICE-PRESIDENT) |
| Authorized Official Telephone | 8154595600 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
019018137 | IL | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NPI # DR. JOHN RICHARD | 1700865441 | 01 | |
| IL | 019018137 | 05 | |
| ID | 019025282 | 05 | |
| IL | 019013457 | 05 | |
| IL | 019016621 | 05 |
| Street Address |
690 N IL ROUTE 31 |
| City | CRYSTAL LAKE |
| State | IL |
| Zip Code | 60012-3790 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568709988 | Pediatric Dental Associates, PC | Dentist | 690 N Il Route 31, Suite D, Crystal Lake, IL 60012-3790 | 2013-01-04 |
| 1053603365 | Candace Marie Opon | Dentist | 690 N Il Route 31, Crystal Lake, IL 60012-3790 | 2011-05-04 |
| 1720150097 | Dennis James Mcdowell | Dentist | 690 N Il Route 31, Suite E, Crystal Lake, IL 60012-3790 | 2006-11-14 |
| 1871662486 | Frazier & Kopp Dds PC | Dentist | 690 N Il Route 31, Crystal Lake, IL 60012-3790 | 2006-11-07 |
| 1528144607 | Thomas Arthur Kopp | Dentist | 690 N Il Route 31, Crystal Lake, IL 60012-3790 | 2006-10-31 |
| 1063526796 | Fred M Fitzpatrick | Dentist | 690 N Il Route 31, Crystal Lake, IL 60012-3790 | 2006-08-19 |
| 1700990447 | Frederick M. Fitzpatrick, D.d.s., P.C. | Dentist | 690 N Il Route 31, Crystal Lake, IL 60012-3790 | 2006-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033574629 | Joan M Ryan | Counselor | 610 N Route 31, Suite E, Crystal Lake, IL 60012 | 2015-12-23 |
| 1285972331 | Lauren Elyse Westerman | Physical Therapist | 1000 Brighton Ln, Crystal Lake, IL 60012 | 2013-01-24 |
| 1447537469 | Sean Gale | Pharmacist | 135 Carmella Dr, Crystal Lake, IL 60012 | 2011-11-04 |
| 1477836625 | Judy Meekyung Fakhouri | Pharmacist | 315 N. Route 31, Crystal Lake, IL 60012 | 2011-09-23 |
| 1730462136 | Leslie Dawn Weckerlin | Pharmacist | 315 N Route 31, Crystal Lake, IL 60012 | 2011-09-21 |
| 1639452188 | Laura Jean Galles | Pharmacist | 315 N. Routet 31, Crystal Lake, IL 60012 | 2011-09-21 |
| 1326320516 | Stacey Jean Knuth | Pharmacist | 315 North Route 31, Crystal Lake, IL 60012 | 2011-09-13 |
| 1356469803 | Donn Orien Humphries | Chiropractor | 690 N Route 31, Suite F, Crystal Lake, IL 60012 | 2007-03-26 |
| 1538204508 | Midwest Physical Therapy Ctr | Clinic/Center | 630 N Rt 31, Suite 103, Crystal Lake, IL 60012 | 2007-02-20 |
| 1356488415 | Charlotte Joy Parcels | Social Worker | 8600 Route 14, Suite 110, Crystal Lake, IL 60012 | 2007-01-30 |
| Find all providers in zip 60012 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154339448 | Kurt Bruksch | Dentist | 690 North Route #31, Crystal Lake, IL 60012 | 2006-08-03 |
| 1215955745 | Michael Edwin Jones | Dentist | 1500 Carlemont Dr, Suite #f, Crystal Lake, IL 60014-1833 | 2006-07-17 |
| 1477592061 | Gregory A Lehman | Dentist | 850 Munshaw Lane, Crystal Lake, IL 60014 | 2006-06-06 |
| 1700865441 | John Joseph Richard | Dentist | 690 North Route 31, Crystal Lake, IL 60012 | 2006-01-11 |
| 1194942110 | Lehman & Menis Oral & Maxillofacial Surgery, P.C. | Dentist | 850 Munshaw Lane, Crystal Lake, IL 60014-1731 | 2007-04-19 |
| 1013028398 | Mej & Associates Enterprises LLC | Dentist | 1500 Carlemont Dr, Suite #f, Crystal Lake, IL 60014-1833 | 2006-08-31 |
| 1912918608 | Thomas J Skiba | Dentist | 690 North Route 31, Crystal Lake, IL 60012 | 2006-08-10 |
| 1033127238 | Adam Ozment | Dentist | 690 North Route 31, Crystal Lake, IL 60012 | 2006-08-03 |
| 1336185305 | Michael A Menis | Dentist | 850 Munshaw Lane, Crystal Lake, IL 60014 | 2006-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255986576 | Othman Rezki | Dentist | 1900 W Polk St # 611, Chicago, IL 60612-3723 | 2019-08-04 |
| 1215410584 | David Peterson | Dentist | 1619 Brandywine Ln, Dixon, IL 61021-8757 | 2018-09-12 |
| 1952887374 | Winnebago Braces, LLC. | Dentist | 555 N Court St Ste 110, Rockford, IL 61103-6898 | 2018-07-18 |
| 1093232951 | Robert C. Bosack, Dds & Associates, Ltd | Dentist | 16011 108th Ave Ste A, Orland Park, IL 60467-8787 | 2017-08-23 |
| 1790146132 | Family Millennium Dentistry, Inc. | Dentist | 1342 W Randolph St, Chicago, IL 60607-1522 | 2016-03-13 |
| 1770962375 | Eunsu Jung | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2015-05-28 |
| 1811374945 | Alexandria Hawkins | Dentist | 6050 Brynwood Dr Ste 102, Rockford, IL 61114-6579 | 2015-04-27 |
| 1043607872 | Alissa Nicole Pullos | Dentist | 105 E 1st St Ste 103, Hinsdale, IL 60521 | 2015-04-20 |
| 1538592654 | Matthew Seena Hamedani | Dentist | 3116 Oak Park Ave, Berwyn, IL 60402 | 2013-08-13 |
| 1578907689 | M Timothy Murphy | Dentist | 500 Davis St Ste 509, Evanston, IL 60201-4621 | 2013-04-18 |
| Find all providers with the same taxonomy | ||||
| City | CRYSTAL LAKE |
| Zip Code | 60012 |
Please comment or provide details below to improve the information on CRYSTAL LAKE ORAL MAXILLOFACIAL SURGERY LTD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.