Provider Demographics
NPI:1457922049
Name:CRYSTAL DENTAL CLINIC, LTD.
Entity Type:Organization
Organization Name:CRYSTAL DENTAL CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELZBIETA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:STOJKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-301-7950
Mailing Address - Street 1:1752 W WISE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3524
Mailing Address - Country:US
Mailing Address - Phone:847-301-7950
Mailing Address - Fax:847-301-0560
Practice Address - Street 1:1752 W WISE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3524
Practice Address - Country:US
Practice Address - Phone:847-301-7950
Practice Address - Fax:847-301-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty