Provider Demographics
NPI:1689791550
Name:NUDERA, JAMES A (DDS, MS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:NUDERA
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:17 N LOOMIS ST
Mailing Address - Street 2:UNIT 1B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1914
Mailing Address - Country:US
Mailing Address - Phone:312-733-3192
Mailing Address - Fax:
Practice Address - Street 1:81 S. MCLEAN BLVD.
Practice Address - Street 2:UNIT B
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177
Practice Address - Country:US
Practice Address - Phone:847-760-6353
Practice Address - Fax:847-760-6356
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics