Provider Demographics
NPI:1326373093
Name:NONNENMANN, MICHAEL J (DDS,MS,LTD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:NONNENMANN
Suffix:
Gender:M
Credentials:DDS,MS,LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 24TH STREET
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201
Mailing Address - Country:US
Mailing Address - Phone:309-794-9365
Mailing Address - Fax:309-794-9903
Practice Address - Street 1:2513 24TH STREET
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:309-794-9365
Practice Address - Fax:309-794-9903
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190149441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics