Provider Demographics
NPI:1134130008
Name:DICKENS, MASON & KISSELL DDS LTD
Entity Type:Organization
Organization Name:DICKENS, MASON & KISSELL DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-584-5444
Mailing Address - Street 1:2035 FOXFIELD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5748
Mailing Address - Country:US
Mailing Address - Phone:630-584-5444
Mailing Address - Fax:630-584-5724
Practice Address - Street 1:2035 FOXFIELD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5748
Practice Address - Country:US
Practice Address - Phone:630-584-5444
Practice Address - Fax:630-584-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190205351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty