Provider Demographics
NPI:1891137170
Name:DUSTOOR, AMY MARIE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:DUSTOOR
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:KRUKEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1921 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1921 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1351
Practice Address - Country:US
Practice Address - Phone:773-276-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190293691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics