Provider Demographics
NPI:1124490875
Name:HOWARD L. CRYSTAL, D.D.S., P.C.
Entity type:Organization
Organization Name:HOWARD L. CRYSTAL, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:CRYSTAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-370-6307
Mailing Address - Street 1:929 RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1559
Mailing Address - Country:US
Mailing Address - Phone:847-906-3480
Mailing Address - Fax:
Practice Address - Street 1:929 RIDGE RD.
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1559
Practice Address - Country:US
Practice Address - Phone:847-906-3480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019016617261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9178032Medicaid