Provider Demographics
NPI:1083698054
Name:FISCHMAN, STEVEN A (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:FISCHMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 LARKDALE EAST RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5055
Mailing Address - Country:US
Mailing Address - Phone:847-436-5077
Mailing Address - Fax:847-940-9885
Practice Address - Street 1:5137 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-2904
Practice Address - Country:US
Practice Address - Phone:847-436-5077
Practice Address - Fax:847-940-9885
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice