=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841590577
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAN BUSKIRK & KRISCHKE, D.D.S., L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2010
-----------------------------------------------------
Last Update Date | 10/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 N MAIN ST SUITE 5
-----------------------------------------------------
City | CROWN POINT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46307-3278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-663-2576
-----------------------------------------------------
Fax | 219-663-3340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 N MAIN ST SUITE 5
-----------------------------------------------------
City | CROWN POINT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46307-3278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-663-2576
-----------------------------------------------------
Fax | 219-663-3340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ROSE RISTOVSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 219-663-2576
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------