Provider Demographics
NPI:1629374046
Name:JASON R. CRESCENZO, DDS, P.C.
Entity Type:Organization
Organization Name:JASON R. CRESCENZO, DDS, P.C.
Other - Org Name:AESTHETIC FAMILY DENTAL OF TINLEY PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRESCENZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-781-9754
Mailing Address - Street 1:16345 HARLEM AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2589
Mailing Address - Country:US
Mailing Address - Phone:708-781-9754
Mailing Address - Fax:708-781-9758
Practice Address - Street 1:16345 HARLEM AVE STE 160
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2589
Practice Address - Country:US
Practice Address - Phone:708-781-9754
Practice Address - Fax:708-781-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027570261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental