Provider Demographics
NPI:1871718452
Name:FISCHL DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:FISCHL DENTAL ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISCHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-864-0822
Mailing Address - Street 1:636 CHURCH STREET
Mailing Address - Street 2:SUITE 200W
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4578
Mailing Address - Country:US
Mailing Address - Phone:847-864-0822
Mailing Address - Fax:847-864-9799
Practice Address - Street 1:636 CHURCH STREET
Practice Address - Street 2:SUITE 200W
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4578
Practice Address - Country:US
Practice Address - Phone:847-864-0822
Practice Address - Fax:847-864-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
IL060006229 0200043571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty