Provider Demographics
NPI:1235350232
Name:JESEK, WARREN F (DDS)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:F
Last Name:JESEK
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 1:3040 S MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-9771
Mailing Address - Country:US
Mailing Address - Phone:217-864-4494
Mailing Address - Fax:217-864-4486
Practice Address - Street 1:3040 S MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-9771
Practice Address - Country:US
Practice Address - Phone:217-864-4494
Practice Address - Fax:217-864-4486
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190166691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice