Provider Demographics
NPI:1225196173
Name:TEUSCHER DENTAL GROUP
Entity Type:Organization
Organization Name:TEUSCHER DENTAL GROUP
Other - Org Name:MICHAEL T TEUSCHER DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TEUSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-762-0000
Mailing Address - Street 1:40 W 320 LAFOX ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ST. CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175
Mailing Address - Country:US
Mailing Address - Phone:630-762-0000
Mailing Address - Fax:
Practice Address - Street 1:40 W 320 LAFOX ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175
Practice Address - Country:US
Practice Address - Phone:630-762-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty