Provider Demographics
NPI:1235283821
Name:DRS. KREUZ AND DUFFNER, DDS, LTD.
Entity Type:Organization
Organization Name:DRS. KREUZ AND DUFFNER, DDS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-798-6868
Mailing Address - Street 1:18040 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1606
Mailing Address - Country:US
Mailing Address - Phone:708-798-6868
Mailing Address - Fax:708-798-6988
Practice Address - Street 1:18040 PARK AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1606
Practice Address - Country:US
Practice Address - Phone:708-798-6868
Practice Address - Fax:708-798-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190197821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty