MEDICARE: FISCHL DENTAL ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	060006229 020004357	IL
2	122300000X	Dentist

General Provider Information

NPI Number	:	1871718452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISCHL DENTAL ASSOCIATES, P.C.

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

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

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAUL L FISCHL
Credential	:	D.D.S.
Telephone Number	:	847-864-0822

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/29/2020

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