Provider Demographics
NPI:1841590577
Name:VAN BUSKIRK & KRISCHKE, D.D.S., L.L.C.
Entity Type:Organization
Organization Name:VAN BUSKIRK & KRISCHKE, D.D.S., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RISTOVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-663-2576
Mailing Address - Street 1:250 N MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3278
Mailing Address - Country:US
Mailing Address - Phone:219-663-2576
Mailing Address - Fax:219-663-3340
Practice Address - Street 1:250 N MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3278
Practice Address - Country:US
Practice Address - Phone:219-663-2576
Practice Address - Fax:219-663-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty