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Organization
CRYSTAL LAKE ORAL MAXILLOFACIAL SURGERY LTD
Active
Organization
CRYSTAL LAKE ORAL MAXILLOFACIAL SURGERY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KURT E BRUKSCH D.D.S. (VICE-PRESIDENT)
(815) 459-5600
Entity
Organization
Contact information
Practice address
690 N IL ROUTE 31, CRYSTAL LAKE, IL 60012-3790
(815) 459-5600
(815) 459-5615
Mailing address
690 N IL ROUTE 31, CRYSTAL LAKE, IL 60012-3790
(815) 459-5600
(815) 459-5615
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019018137
IL
Other
Enumeration date
08/05/2006
Last updated
06/03/2010
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