Provider Demographics
NPI:1962615450
Name:RAUSCHERT, FRED (DDS)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:RAUSCHERT
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 1:1025 W WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3502
Mailing Address - Country:US
Mailing Address - Phone:773-348-0303
Mailing Address - Fax:773-348-7940
Practice Address - Street 1:1025 W WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3502
Practice Address - Country:US
Practice Address - Phone:773-348-0303
Practice Address - Fax:773-348-7940
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist