Provider Demographics
NPI:1669425005
Name:FISCHER, DENA J (DDS,MSD,MS)
Entity type:Individual
Prefix:DR
First Name:DENA
Middle Name:J
Last Name:FISCHER
Suffix:
Gender:F
Credentials:DDS,MSD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N SEMINARY AVE APT E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1380
Mailing Address - Country:US
Mailing Address - Phone:312-513-0323
Mailing Address - Fax:312-355-2688
Practice Address - Street 1:UNIVERSITY OF ILLINOIS AT CHICAGO
Practice Address - Street 2:801 S PAULINA STREET, MC 838
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7213
Practice Address - Country:US
Practice Address - Phone:312-996-1105
Practice Address - Fax:312-355-2688
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000089731223G0001X
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice