Provider Demographics
NPI:1912171950
Name:MICHAEL J. KROL D.D.S. P.C.
Entity Type:Organization
Organization Name:MICHAEL J. KROL D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KROL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-943-5939
Mailing Address - Street 1:710 W BRINK ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-2720
Mailing Address - Country:US
Mailing Address - Phone:815-943-5939
Mailing Address - Fax:
Practice Address - Street 1:710 W BRINK ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-2720
Practice Address - Country:US
Practice Address - Phone:815-943-5939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019-019140OtherDENTAL LICENSE 019-019140