Healthcare Provider Details

I. General information

NPI: 1144526948
Provider Name (Legal Business Name): DAVID D JANES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N MADISON ST
WOODSTOCK IL
60098-3450
US

IV. Provider business mailing address

210 N MADISON ST
WOODSTOCK IL
60098-3450
US

V. Phone/Fax

Practice location:
  • Phone: 815-338-7569
  • Fax: 815-338-1070
Mailing address:
  • Phone: 815-338-7569
  • Fax: 815-338-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019015666
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: