Provider Demographics
NPI:1679767461
Name:AMRAM, JAMES DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:AMRAM
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 1:1390 MAIN STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2958
Mailing Address - Country:US
Mailing Address - Phone:708-672-1473
Mailing Address - Fax:
Practice Address - Street 1:1390 MAIN STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-2958
Practice Address - Country:US
Practice Address - Phone:708-672-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist