Provider Demographics
NPI:1265817977
Name:SIMPSON, CRYSTAL ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:ANN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:ANN
Other - Last Name:COMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:OQUAWKA
Mailing Address - State:IL
Mailing Address - Zip Code:61469
Mailing Address - Country:US
Mailing Address - Phone:309-867-2202
Mailing Address - Fax:309-867-2789
Practice Address - Street 1:1204 HWY 164 E.
Practice Address - Street 2:
Practice Address - City:OQUAWKA
Practice Address - State:IL
Practice Address - Zip Code:61469
Practice Address - Country:US
Practice Address - Phone:309-867-2202
Practice Address - Fax:309-867-2789
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0303031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice