Provider Demographics
NPI:1831812007
Name:CRYSTAL CHOPP, DDS, PLLC
Entity type:Organization
Organization Name:CRYSTAL CHOPP, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-365-3565
Mailing Address - Street 1:40 N 1ST AVE E STE 5
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1269
Mailing Address - Country:US
Mailing Address - Phone:218-365-3565
Mailing Address - Fax:218-365-3515
Practice Address - Street 1:40 N 1ST AVE E STE 5
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1269
Practice Address - Country:US
Practice Address - Phone:218-365-3565
Practice Address - Fax:218-365-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental