Healthcare Provider Details

I. General information

NPI: 1902926330
Provider Name (Legal Business Name): NUDERA ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 S. MCLEAN BLVD., UNIT B
SOUTH ELGIN IL
60177
US

IV. Provider business mailing address

81 S. MCLEAN BLVD., UNIT B
SOUTH ELGIN IL
60177
US

V. Phone/Fax

Practice location:
  • Phone: 847-760-6353
  • Fax: 847-760-6356
Mailing address:
  • Phone: 847-760-6353
  • Fax: 847-760-6356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number60009337
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES A. NUDERA
Title or Position: OWNER
Credential: DDS, MS
Phone: 847-760-6353