Provider Demographics
NPI:1720291651
Name:CRYSTAL, HOWARD LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:LAWRENCE
Last Name:CRYSTAL
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 1:5040 WARREN ST APT 305
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2913
Mailing Address - Country:US
Mailing Address - Phone:773-370-6307
Mailing Address - Fax:
Practice Address - Street 1:4334 FOX VALLEY CENTER DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7945
Practice Address - Country:US
Practice Address - Phone:630-366-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002669-151223G0001X
IL0190166171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9178032Medicaid