Individual provider Active NPI

Howard Lawrence Crystal, D.D.S.

  • General Practice Dentistry
  • Aurora, IL
National Provider Identifier
1720291651
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019016617 Issued in IL
Practice address
4334 Fox Valley Center Dr
Aurora, IL 60504-7945
Phone
(630) 366-2370
NPI assigned
May 7, 2007
Last updated
Feb 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1002669-15 WI
General Practice Dentistry 1223G0001X 019016617 IL Primary

Addresses

Primary practice location

4334 Fox Valley Center Dr
Aurora, IL 60504-7945

Mailing address

5040 Warren St Apt 305
Skokie, IL 60077-2913
Phone (773) 370-6307

Other identifiers 1

IdentifierTypeStateIssuer
9178032MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150113001010 IL Order and Referring Only - Other (Non-Physician) 2769706175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1002669-15WIMDGeneral Practice Dentistry

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1720291651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5040 WARREN ST APT 305",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600772913",
            "telephone_number": "773-370-6307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4334 FOX VALLEY CENTER DR",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605047945",
            "telephone_number": "630-366-2370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRYSTAL",
        "first_name": "HOWARD",
        "middle_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002669-15",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019016617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9178032",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

Verify at the official NPI Registry.