Provider Demographics
NPI:1851537237
Name:CO, CRISTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:
Last Name:CO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:CO FUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7001 W OGDEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3652
Mailing Address - Country:US
Mailing Address - Phone:708-749-2419
Mailing Address - Fax:708-749-2429
Practice Address - Street 1:7001 W OGDEN AVENUE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3652
Practice Address - Country:US
Practice Address - Phone:708-749-2419
Practice Address - Fax:708-749-2429
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190225221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice