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General NPI Number Information
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NPI Number | 1962560821
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Entity Type | Individual
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Provider Name | MARTIN GERARD JANECKE DDS
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 727 MAIN ST
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City | PECATONICA
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State | IL
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Zip | 61063-0608
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Country | US
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Telephone | 815-239-1313
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Fax | 815-239-9014
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Provider Business Mailing Address
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Address Line | 727 MAIN ST PO BOX 608
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City | PECATONICA
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State | IL
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Zip | 61063-0608
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Country | US
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Telephone | 815-239-1313
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Fax | 815-239-9014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | IL
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