Provider Demographics
NPI:1154424778
Name:HOCHSTADTER ISAACSON CHERNY DUMANIS & ASSOC MAXILLO SURGERY LTD
Entity type:Organization
Organization Name:HOCHSTADTER ISAACSON CHERNY DUMANIS & ASSOC MAXILLO SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:ISAACSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-296-6100
Mailing Address - Street 1:444 N NORTHWEST HWY
Mailing Address - Street 2:STE 325
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-296-6100
Mailing Address - Fax:847-296-8706
Practice Address - Street 1:444 N NORTHWEST HWY
Practice Address - Street 2:STE 325
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-296-6100
Practice Address - Fax:847-296-8706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0600080651223S0112X
IL0600089141223S0112X
IL0210008121223S0112X
IL0210011971223S0112X
IL0210222011223S0112X
IL0210021521223S0112X
IL0210021671223S0112X
IL0210003871223S0112X
IL0600089131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0080004915OtherBC
IL0080004915OtherBC
209681Medicare ID - Type Unspecified