Provider Demographics
NPI:1598871295
Name:WANDERS, JOSEPH ALBERT (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALBERT
Last Name:WANDERS
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 1:233 W ST CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2232
Mailing Address - Country:US
Mailing Address - Phone:630-916-4511
Mailing Address - Fax:630-916-8557
Practice Address - Street 1:233 W ST CHARLES RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2232
Practice Address - Country:US
Practice Address - Phone:630-916-4511
Practice Address - Fax:630-916-8557
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1915258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist