| Crystal Lake Oral Maxillofacial Surgery Ltd | |
|
690 N Il Route 31 Crystal Lake IL 60012-3790 | |
| (815) 459-5600 | |
| (815) 459-5615 |
| Full Name | Crystal Lake Oral Maxillofacial Surgery Ltd |
|---|---|
| Speciality | Dentist |
| Location | 690 N Il Route 31, Crystal Lake, Illinois |
| Authorized Official Name and Position | Kurt E Bruksch (VICE-PRESIDENT) |
| Authorized Official Contact | 8154595600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Lake Oral Maxillofacial Surgery Ltd 690 N Il Route 31 Crystal Lake IL 60012-3790 Ph: (815) 459-5600 | Crystal Lake Oral Maxillofacial Surgery Ltd 690 N Il Route 31 Crystal Lake IL 60012-3790 Ph: (815) 459-5600 |
| NPI Number | 1730197468 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 06/03/2010 |
| Medicare PECOS PAC ID | 6608900196 |
|---|---|
| Medicare Enrollment ID | O20100819000633 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730197468 | NPI | - | NPPES |
| 019025282 | Medicaid | ID | |
| 019016621 | Medicaid | IL | |
| 019018137 | Medicaid | IL | |
| 019013457 | Medicaid | IL | |
| 1700865441 | Other | NPI # DR. JOHN RICHARD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 019018137 (Illinois) | Primary |
Hoffman Orthodontics Ltd Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 521 Devonshire Ln, Crystal Lake, IL 60014 Phone: 815-459-3434 Fax: 815-459-3498 | |
Hoffman Orthodontics Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 521 Devonshire Ln, Crystal Lake, IL 60014 Phone: 815-459-3434 Fax: 815-459-3498 | |
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