1871718452 NPI number — FISCHL DENTAL ASSOCIATES, P.C.

Table of content: (NPI 1871718452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871718452 NPI number — FISCHL DENTAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FISCHL DENTAL ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871718452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
636 CHURCH STREET
Provider Second Line Business Mailing Address:
SUITE 200W
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60201-4578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-864-0822
Provider Business Mailing Address Fax Number:
847-864-9799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
636 CHURCH STREET
Provider Second Line Business Practice Location Address:
SUITE 200W
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-4578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-864-0822
Provider Business Practice Location Address Fax Number:
847-864-9799
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FISCHL
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-864-0822

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 060006229 020004357 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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