Provider Demographics
NPI:1760529754
Name:NATHAN, JOHN E (DDS MDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:NATHAN
Suffix:
Gender:M
Credentials:DDS MDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5311 BENDING OAKS CT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-964-8575
Mailing Address - Fax:630-964-8692
Practice Address - Street 1:815 COMMERCE
Practice Address - Street 2:SUITE 220
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-574-7336
Practice Address - Fax:630-574-9331
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry