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Individual

BRENDA R FABISCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
6518 N CLARK ST, CHICAGO, IL 66626-4002
(773) 262-5600
(773) 572-8238
Mailing address
6518 N CLARK ST, CHICAGO, IL 66626-4002
(773) 262-5600
(773) 572-8238

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1001787
IL
Enumeration date
05/08/2007
Last updated
07/09/2007
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