Provider Demographics
NPI:1780795526
Name:TISCHLER, CRAIG L (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:L
Last Name:TISCHLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 54 97TH PLACE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-592-2207
Mailing Address - Fax:718-592-8713
Practice Address - Street 1:62 54 97TH PLACE
Practice Address - Street 2:SUITE 2A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1354
Practice Address - Country:US
Practice Address - Phone:718-592-2207
Practice Address - Fax:718-592-8713
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist