Provider Demographics
NPI:1700777695
Name:CRNKOVICH, MADYSON ANGLIM (DDS)
Entity type:Individual
Prefix:DR
First Name:MADYSON
Middle Name:ANGLIM
Last Name:CRNKOVICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MADYSON
Other - Middle Name:
Other - Last Name:ANGLIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3022
Mailing Address - Country:US
Mailing Address - Phone:402-650-4924
Mailing Address - Fax:
Practice Address - Street 1:2800 COLLEGE AVE BLDG 263
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4700
Practice Address - Country:US
Practice Address - Phone:618-474-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL018.0023261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty