Provider Demographics
NPI:1659581528
Name:DAVID D JANES DDS, PC
Entity Type:Organization
Organization Name:DAVID D JANES DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:JANES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-338-7569
Mailing Address - Street 1:210 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3450
Mailing Address - Country:US
Mailing Address - Phone:815-338-7569
Mailing Address - Fax:815-338-1070
Practice Address - Street 1:210 N MADISON ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3450
Practice Address - Country:US
Practice Address - Phone:815-338-7569
Practice Address - Fax:815-338-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-A15666261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental