Provider Demographics
NPI:1730370362
Name:KRUEGER-SWADE, KARYN (DDS)
Entity type:Individual
Prefix:MRS
First Name:KARYN
Middle Name:
Last Name:KRUEGER-SWADE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1743
Mailing Address - Country:US
Mailing Address - Phone:708-784-8925
Mailing Address - Fax:
Practice Address - Street 1:4716 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1743
Practice Address - Country:US
Practice Address - Phone:708-784-8925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2018-11-30
Deactivation Date:2017-09-30
Deactivation Code:
Reactivation Date:2018-11-30
Provider Licenses
StateLicense IDTaxonomies
IL0190232141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice