Provider Demographics
NPI:1629186937
Name:CHINLUND, DONALD BRUCE (DDS, LLC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BRUCE
Last Name:CHINLUND
Suffix:
Gender:M
Credentials:DDS, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E CRYSTAL LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6171
Mailing Address - Country:US
Mailing Address - Phone:815-459-8650
Mailing Address - Fax:815-455-9503
Practice Address - Street 1:77 E CRYSTAL LAKE AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6171
Practice Address - Country:US
Practice Address - Phone:815-459-8650
Practice Address - Fax:815-455-9503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice