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CRYSTAL LAKE ORAL MAXILLOFACIAL SURGERY LTD NPI 1730197468


NPI Information

NPI: 1730197468
Provider Name: CRYSTAL LAKE ORAL MAXILLOFACIAL SURGERY LTD
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
690 N IL ROUTE 31
CRYSTAL LAKE, IL
ZIP 60012
Phone: (815) 459-5600
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CRYSTAL LAKE ORAL MAXILLOFACIAL SURGERY LTD is an oral and maxillofacial surgery dentist in Crystal Lake, IL. The provider is an oral and maxillofacial surgery dentist specialized in 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. CRYSTAL LAKE ORAL MAXILLOFACIAL SURGERY LTD NPI is 1730197468. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

690 N IL ROUTE 31
CRYSTAL LAKE, IL
ZIP 60012-790
Phone: (815) 459-5600
Fax: (815) 459-5615

The provider's authorized official is Kurt E Bruksch .
The authorized official title is Vice-president and has the following contact phone number (815) 459-5600.

The enumeration date for this NPI number is 8/5/2006 and was last updated on 6/3/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial Surgery019018137ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1761910MEDICARE ID-TYPE UNSPECIFIEDILLINOISDR. KURT BRUKSCH
21700865441OTHERNPI # DR. JOHN RICHARD
3019013457MEDICAIDILLINOIS
4T37819MEDICARE UPINILLINOIS
5U81648MEDICARE UPINILLINOIS
6206350MEDICARE ID-TYPE UNSPECIFIEDILLINOISDR. THOMAS SKIBA
7594150MEDICARE ID-TYPE UNSPECIFIEDILLINOISDR. ADAM OZMENT
8019018137MEDICAIDILLINOIS
9019025282MEDICAIDIDAHO
10T38692MEDICARE UPINILLINOIS
11019016621MEDICAIDILLINOIS
12T35304MEDICARE UPINILLINOIS
13683930MEDICARE ID-TYPE UNSPECIFIEDILLINOISDR. ROBERT CONLON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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