Provider Demographics
NPI:1891984852
Name:KISKER DENTAL ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:KISKER DENTAL ASSOCIATES, LTD.
Other - Org Name:DENTAL CARE OF VERNON HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:KISKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-918-0001
Mailing Address - Street 1:701 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1556
Mailing Address - Country:US
Mailing Address - Phone:847-918-0001
Mailing Address - Fax:847-918-8714
Practice Address - Street 1:701 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1556
Practice Address - Country:US
Practice Address - Phone:847-918-0001
Practice Address - Fax:847-918-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental