Healthcare Provider Details

I. General information

NPI: 1255428637
Provider Name (Legal Business Name): JAMES M FIELDHOUSE DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SHERWOOD ROAD
LA GRANGE PARK IL
60526-1967
US

IV. Provider business mailing address

360 SHERWOOD ROAD
LA GRANGE PARK IL
60526-1967
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-7363
  • Fax: 708-354-7371
Mailing address:
  • Phone: 708-354-7363
  • Fax: 708-354-7371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name: JAMES MCKAY FIELDHOUSE
Title or Position: PRESIDENT
Credential: DDS
Phone: 708-354-7363