Provider Demographics
NPI:1508069717
Name:FUERTGES, DANIEL B (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:FUERTGES
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:PO BOX 624
Mailing Address - Street 2:101 N MAIN ST
Mailing Address - City:WALNUT
Mailing Address - State:IL
Mailing Address - Zip Code:61376-0624
Mailing Address - Country:US
Mailing Address - Phone:815-379-9012
Mailing Address - Fax:815-379-2762
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:IL
Practice Address - Zip Code:61376-0624
Practice Address - Country:US
Practice Address - Phone:815-379-9012
Practice Address - Fax:815-379-2762
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice