Provider Demographics
NPI:1790045490
Name:TISCHKE, GAIL (DDS, MS)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:TISCHKE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 S BRUNER ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4384
Mailing Address - Country:US
Mailing Address - Phone:847-477-0847
Mailing Address - Fax:
Practice Address - Street 1:555 PLAINFIELD RD STE E
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7619
Practice Address - Country:US
Practice Address - Phone:630-686-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028991122300000X
IL021-0029751223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist