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General NPI Number Information
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NPI Number | 1902393465
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Entity Type | Organization
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Legal Business Name | FRATMISHIN J. ALEXANDER
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 6408 N CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60645-5209
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Country | US
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Telephone | 773-338-6565
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Fax | 773-338-6552
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Provider Business Mailing Address
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Address Line | PO BOX 597770
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City | CHICAGO
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State | IL
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Zip | 60659-7770
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Country | US
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Telephone | 773-338-6565
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Fax | 773-338-6552
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AUGANIA JOHN ALEXANDER
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Credential |
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Telephone | 773-338-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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