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General NPI Number Information
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NPI Number | 1891984852
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Entity Type | Organization
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Legal Business Name | KISKER DENTAL ASSOCIATES, LTD.
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 701 N MILWAUKEE AVE SUITE 320
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City | VERNON HILLS
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State | IL
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Zip | 60061-1556
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Country | US
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Telephone | 847-918-0001
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Fax | 847-918-8714
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Provider Business Mailing Address
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Address Line | 701 N MILWAUKEE AVE SUITE 320
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City | VERNON HILLS
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State | IL
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Zip | 60061-1556
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Country | US
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Telephone | 847-918-0001
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Fax | 847-918-8714
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM RYAN KISKER
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Credential | DMD
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Telephone | 847-918-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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