Krystle Grandberry Widen, DMD

General Practice Dentistry · Oak Park, IL

Individual Active NPI

NPI number 1063942159

Practice location

1113 Chicago Ave
Oak Park, IL 60302-1803
Phone
(708) 383-0500

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NPI record

NPI
1063942159
Entity type
Individual (Type 1)
Enumeration date
June 12, 2017
Last updated
February 16, 2024
Certified
February 16, 2024
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
General Practice Dentistry Primary 1223G0001X 019.033543 IL

Mailing address

2307 W Melrose St
Chicago, IL 60618-6317

About Dr. Widen

Krystle Grandberry Widen, DMD is a healthcare provider registered in the NPI registry with the primary taxonomy General Practice Dentistry (code 1223G0001X). The practice location is 1113 Chicago Ave, Oak Park, IL 60302-1803. The NPI number 1063942159 was assigned on June 12, 2017 and the record was last updated on February 16, 2024.

Dr. Widen lists a license in the registry: #019.033543 (IL) for General Practice Dentistry. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Krystle Grandberry Widen, DMD?

The NPI number is 1063942159.

What is the phone number of Dr. Widen?

The phone number listed for the practice location is (708) 383-0500.

Where is Dr. Widen located?

1113 Chicago Ave, Oak Park, IL 60302-1803.

What is the taxonomy code for Dr. Widen?

The primary taxonomy code is 1223G0001X – General Practice Dentistry.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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