Provider Demographics
NPI:1124384011
Name:WONDERLICK, ANJANETTA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANJANETTA
Middle Name:MARIE
Last Name:WONDERLICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S WASHINGTON ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7959
Mailing Address - Country:US
Mailing Address - Phone:630-355-5211
Mailing Address - Fax:630-355-5249
Practice Address - Street 1:1112 S WASHINGTON ST
Practice Address - Street 2:SUITE 211
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7959
Practice Address - Country:US
Practice Address - Phone:630-355-5211
Practice Address - Fax:630-355-5249
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0245661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice