Individual
DR. LEO PAUL KRUSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
444 N MAIN ST, GLEN ELLYN, IL 60137
(630) 858-1120
(630) 858-7632
Mailing address
444 N MAIN ST, GLEN ELLYN, IL 60137
(630) 858-1120
(630) 858-7632
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19A-14094
IL
Other
Enumeration date
11/27/2006
Last updated
07/08/2007
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