Krystle Grandberry Widen, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.033543 Issued in IL

Practice address

1113 Chicago Ave
Oak Park, IL 60302-1803

Phone

(708) 383-0500

NPI assigned

Jun 12, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Krystle Grandberry DMD PLLC

  • Dental Clinic/Center
  • Chicago, IL
  • NPI 1255190955
  NPD Authorized official
• Dental Professionals of Illinois, P.C.

  • General Practice Dentistry
  • Oak Park, IL
  • NPI 1376254920
  NPD
• 42 North Dental Care, LLC

  • Dental Clinic/Center
  • Chelmsford, MA
  • NPI 1558630301
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1063942159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 W MELROSE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 CHICAGO AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021803",
            "telephone_number": "708-383-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDEN",
        "first_name": "KRYSTLE",
        "middle_name": "GRANDBERRY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-12",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.033543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Whitfield, MD
• Lenise Tonya Whitman, MA
• Marqus Whitman
• Wholehealth Therapy Partners, Inc
• Wholistic Health Center of Oak Park, Inc.
• Janis Wiener, MD
• Theresa Marie Wier, PSYD, LPC
• Hannah Joan Wilcox
• Kathryn L Wilford, LCPC, RPT, CTC
• Tessa Dianne Wilhelm

• General Practice Dentistry in Oak Park, IL
• Providers in Oak Park, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.