Provider Demographics
NPI:1841201845
Name:WISNIEWSKI, JAMES H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:WISNIEWSKI
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 1:43 SONOMA DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5173
Mailing Address - Country:US
Mailing Address - Phone:815-886-2933
Mailing Address - Fax:
Practice Address - Street 1:3247 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2129
Practice Address - Country:US
Practice Address - Phone:773-281-8320
Practice Address - Fax:773-281-6996
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist