Provider Demographics
NPI:1841298817
Name:J. MICHAEL KRISKO DDS, LTD.
Entity type:Organization
Organization Name:J. MICHAEL KRISKO DDS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KRISKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-468-1930
Mailing Address - Street 1:508 BARRY TURN
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1657
Mailing Address - Country:US
Mailing Address - Phone:815-468-1930
Mailing Address - Fax:815-939-0920
Practice Address - Street 1:401 N WALL ST
Practice Address - Street 2:STE 206
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2934
Practice Address - Country:US
Practice Address - Phone:815-468-1930
Practice Address - Fax:815-939-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty