Provider Demographics
NPI:1346413010
Name:CHARLES W. JANES, D.D.S. P.C.
Entity Type:Organization
Organization Name:CHARLES W. JANES, D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:JANES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-228-2828
Mailing Address - Street 1:1261 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4275
Mailing Address - Country:US
Mailing Address - Phone:217-228-2828
Mailing Address - Fax:
Practice Address - Street 1:1261 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4275
Practice Address - Country:US
Practice Address - Phone:217-228-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1002348Medicaid