Provider Demographics
NPI:1811026669
Name:KRELL-REUBEN ORAL SURGERY LTD.
Entity Type:Organization
Organization Name:KRELL-REUBEN ORAL SURGERY LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:REUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:773-777-6332
Mailing Address - Street 1:4200 W PETERSON AVE
Mailing Address - Street 2:SUITE 128
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6074
Mailing Address - Country:US
Mailing Address - Phone:773-777-6332
Mailing Address - Fax:
Practice Address - Street 1:4200 W PETERSON AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6074
Practice Address - Country:US
Practice Address - Phone:773-777-6332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty