Healthcare Provider Details

I. General information

NPI: 1487823696
Provider Name (Legal Business Name): JAMES M FIELDHOUSE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SHERWOOD RD
LA GRANGE PARK IL
60526-1967
US

IV. Provider business mailing address

360 SHERWOOD RD
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:
Title or Position:
Credential:
Phone: