Provider Demographics
NPI:1073687927
Name:SANIAT, JOHN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:SANIAT
Suffix:
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 1:200 E WILLOW AVE
Mailing Address - Street 2:#301
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5463
Mailing Address - Country:US
Mailing Address - Phone:630-690-3686
Mailing Address - Fax:630-690-1804
Practice Address - Street 1:200 E WILLOW AVE
Practice Address - Street 2:#301
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5463
Practice Address - Country:US
Practice Address - Phone:630-690-3686
Practice Address - Fax:630-690-1804
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0300XDental ProvidersDentistPeriodontics