Provider Demographics
NPI:1073681862
Name:CHIDESTER, JAMES B SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:CHIDESTER
Suffix:SR
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 1:120 OAKBROOK CENTER MALL
Mailing Address - Street 2:STE 510
Mailing Address - City:OAKBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-571-0393
Mailing Address - Fax:630-571-4510
Practice Address - Street 1:120 OAKBROOK CENTER MALL
Practice Address - Street 2:STE 510
Practice Address - City:OAKBROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-571-0393
Practice Address - Fax:630-571-4510
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190120521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice