Provider Demographics
NPI:1003089251
Name:DCP OF ILLINOIS - CRYSTAL LAKE
Entity Type:Organization
Organization Name:DCP OF ILLINOIS - CRYSTAL LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-930-7707
Mailing Address - Street 1:5875 LANDERBROOK DR
Mailing Address - Street 2:#250
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6511
Mailing Address - Country:US
Mailing Address - Phone:800-487-4867
Mailing Address - Fax:216-593-7533
Practice Address - Street 1:1145 SOUTH ROUTE 31
Practice Address - Street 2:SIUTE J
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60039
Practice Address - Country:US
Practice Address - Phone:815-477-5399
Practice Address - Fax:815-477-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty