Provider Demographics
NPI:1720207236
Name:FURMANEK, JAMES J (JAMES FURMANEK)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:FURMANEK
Suffix:
Gender:M
Credentials:JAMES FURMANEK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 N BROADWAY ST
Mailing Address - Street 2:SUITE 31
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1450
Mailing Address - Country:US
Mailing Address - Phone:773-764-5521
Mailing Address - Fax:773-764-8613
Practice Address - Street 1:6355 N BROADWAY ST
Practice Address - Street 2:SUITE 31
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1450
Practice Address - Country:US
Practice Address - Phone:773-764-5521
Practice Address - Fax:773-764-8613
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A148441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice