Provider Demographics
NPI:1407190150
Name:BISCHOFF DENTISTRY, LTD
Entity Type:Organization
Organization Name:BISCHOFF DENTISTRY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BISCHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-633-7220
Mailing Address - Street 1:6726 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-8625
Mailing Address - Country:US
Mailing Address - Phone:815-633-7220
Mailing Address - Fax:815-633-7295
Practice Address - Street 1:6726 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-8625
Practice Address - Country:US
Practice Address - Phone:815-633-7220
Practice Address - Fax:815-633-7295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty