Provider Demographics
NPI:1699861062
Name:KRABILL, ELVIN MAST (DDS)
Entity type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:MAST
Last Name:KRABILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W PERU ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-1997
Mailing Address - Country:US
Mailing Address - Phone:815-875-6449
Mailing Address - Fax:815-875-9409
Practice Address - Street 1:475 W PERU ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-1997
Practice Address - Country:US
Practice Address - Phone:815-875-6449
Practice Address - Fax:815-875-9409
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice