Healthcare Provider Details

I. General information

NPI: 1700836657
Provider Name (Legal Business Name): DENISE EILEEN FISHER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W DIVISION ST SUITE 130
CHICAGO IL
60622-2717
US

IV. Provider business mailing address

2222 W DIVISION ST SUITE 130
CHICAGO IL
60622-2717
US

V. Phone/Fax

Practice location:
  • Phone: 773-772-7373
  • Fax: 773-772-5667
Mailing address:
  • Phone: 773-772-7373
  • Fax: 773-772-5667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: