NPIMap

Organization Active NPI

Crystal Cove Family Dental PLLC

  • General Practice Dentistry
  • Orland Park, IL
National Provider Identifier
1972392751
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CRYSTAL COVE FAMILY DENTAL PLLC
Practice address
15614 S Harlem Ave Ste a
Orland Park, IL 60462-4401
Phone
(708) 614-1111
Fax
(708) 614-1117
NPI assigned
May 6, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Authorized official

Name
Florentina Camacho
Title
Office Manager
Phone
(708) 614-1111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

15614 S Harlem Ave Ste a
Orland Park, IL 60462-4401

Mailing address

15614 S Harlem Ave Ste a
Orland Park, IL 60462-4401
Phone (708) 614-1111

Other names 1

  • Crystal Cove Family Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1746489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746489600000",
    "number": "1972392751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15614 S HARLEM AVE STE A",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624401",
            "telephone_number": "708-614-1111",
            "fax_number": "708-614-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15614 S HARLEM AVE STE A",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624401",
            "telephone_number": "708-614-1111",
            "fax_number": "708-614-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL COVE FAMILY DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-06",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A",
        "authorized_official_last_name": "CAMACHO",
        "authorized_official_first_name": "FLORENTINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "708-614-1111"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal Cove Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2025; 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.