Individual
DIVYA R KRISHNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
732 N FAIRFIELD RD, ROUND LAKE, IL 60073-8160
(847) 740-4100
(847) 740-4105
Mailing address
732 N FAIRFIELD RD, ROUND LAKE, IL 60073-8160
(847) 740-4100
(847) 740-4105
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019027134
IL
Other
Enumeration date
08/14/2006
Last updated
07/21/2022
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