Provider Demographics
NPI:1861850794
Name:ERIKA L KROUTH DDS PC
Entity Type:Organization
Organization Name:ERIKA L KROUTH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KROUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-554-5244
Mailing Address - Street 1:1016 DOUGLAS RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9865
Mailing Address - Country:US
Mailing Address - Phone:630-554-5244
Mailing Address - Fax:
Practice Address - Street 1:1016 DOUGLAS RD UNIT A
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9865
Practice Address - Country:US
Practice Address - Phone:630-554-5244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026134122300000X
IL019030387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty