Provider Demographics
NPI:1053896183
Name:TEUSCHER DENTAL
Entity type:Organization
Organization Name:TEUSCHER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TEUSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-762-0000
Mailing Address - Street 1:40W320 LAFOX RD STE D
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6545
Mailing Address - Country:US
Mailing Address - Phone:630-762-0000
Mailing Address - Fax:
Practice Address - Street 1:40W320 LAFOX RD STE D
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6545
Practice Address - Country:US
Practice Address - Phone:630-762-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty