Provider Demographics
NPI:1437403367
Name:CARLSON, CASTOR & HAUF, P.C.
Entity Type:Organization
Organization Name:CARLSON, CASTOR & HAUF, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-203-5608
Mailing Address - Street 1:10775 NORTH ROUTE 47
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142
Mailing Address - Country:US
Mailing Address - Phone:847-669-4771
Mailing Address - Fax:
Practice Address - Street 1:10775 N IL ROUTE 47
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9770
Practice Address - Country:US
Practice Address - Phone:847-669-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190270391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty