Provider Demographics
NPI:1417102963
Name:CHRIS E KRUEGER DDS, LTD
Entity Type:Organization
Organization Name:CHRIS E KRUEGER DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-724-7764
Mailing Address - Street 1:950 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4340
Mailing Address - Country:US
Mailing Address - Phone:847-724-7764
Mailing Address - Fax:847-729-2663
Practice Address - Street 1:950 RIVER DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4340
Practice Address - Country:US
Practice Address - Phone:847-724-7764
Practice Address - Fax:847-729-2663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRIS E KRUEGER DDS, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0190201051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty