Provider Demographics
NPI:1831320654
Name:KELLNER, CRYSTAL BETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:BETT
Last Name:KELLNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N WOOD DALE RD
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1569
Mailing Address - Country:US
Mailing Address - Phone:630-860-9100
Mailing Address - Fax:
Practice Address - Street 1:333 N WOOD DALE RD
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1569
Practice Address - Country:US
Practice Address - Phone:630-860-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist