Provider Demographics
NPI:1598838047
Name:FOLLMER, DAN VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:VINCENT
Last Name:FOLLMER
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 1:615 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-1963
Mailing Address - Country:US
Mailing Address - Phone:847-526-2831
Mailing Address - Fax:847-526-2858
Practice Address - Street 1:615 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1963
Practice Address - Country:US
Practice Address - Phone:847-526-2831
Practice Address - Fax:847-526-2858
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist