Provider Demographics
NPI:1023562857
Name:JWWDENTAL LLC
Entity Type:Organization
Organization Name:JWWDENTAL LLC
Other - Org Name:RENOVO ENDODONTIC STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-517-8330
Mailing Address - Street 1:808 E WOODFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4816
Mailing Address - Country:US
Mailing Address - Phone:847-517-8330
Mailing Address - Fax:
Practice Address - Street 1:808 E WOODFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4816
Practice Address - Country:US
Practice Address - Phone:847-517-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty