Provider Demographics
NPI:1326173030
Name:CHRISMAN DENTAL CARE PC
Entity Type:Organization
Organization Name:CHRISMAN DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILDEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-269-2432
Mailing Address - Street 1:122 W MADISON AVE
Mailing Address - Street 2:P.O. BOX 15
Mailing Address - City:CHRISMAN
Mailing Address - State:IL
Mailing Address - Zip Code:61924-1118
Mailing Address - Country:US
Mailing Address - Phone:217-269-2432
Mailing Address - Fax:219-269-2171
Practice Address - Street 1:122 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:CHRISMAN
Practice Address - State:IL
Practice Address - Zip Code:61924-1118
Practice Address - Country:US
Practice Address - Phone:217-269-2432
Practice Address - Fax:219-269-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental