Organization
CRYSTAL COVE FAMILY DENTAL PLLC
Active
Other names
Crystal Cove Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
FLORENTINA CAMACHO (OFFICE MANAGER)
(708) 614-1111
Entity
Organization
Contact information
Practice address
15614 S HARLEM AVE STE A, ORLAND PARK, IL 60462-4401
(708) 614-1111
(708) 614-1117
Mailing address
15614 S HARLEM AVE STE A, ORLAND PARK, IL 60462-4401
(708) 614-1111
(708) 614-1117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
05/06/2025
Last updated
05/06/2025
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