Provider Demographics
NPI:1417234659
Name:WILNER, NEIL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:S
Last Name:WILNER
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 1:2604 E DEMPSTER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-299-1016
Mailing Address - Fax:847-299-1024
Practice Address - Street 1:2604 E DEMPSTER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-299-1016
Practice Address - Fax:847-299-1024
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190132301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice