Provider Demographics
NPI:1326291998
Name:AMRAM, JACK CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:CHRISTOPHER
Last Name:AMRAM
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 1:1285 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417
Mailing Address - Country:US
Mailing Address - Phone:708-672-0772
Mailing Address - Fax:708-672-0089
Practice Address - Street 1:1285 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417
Practice Address - Country:US
Practice Address - Phone:708-672-0772
Practice Address - Fax:708-672-0089
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist