Provider Demographics
NPI:1891977096
Name:EMIL MOMMERS P.C.
Entity Type:Organization
Organization Name:EMIL MOMMERS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-623-2193
Mailing Address - Street 1:5472 REIMER DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-9228
Mailing Address - Country:US
Mailing Address - Phone:815-623-2193
Mailing Address - Fax:815-623-8804
Practice Address - Street 1:5472 REIMER DR
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9228
Practice Address - Country:US
Practice Address - Phone:815-623-2193
Practice Address - Fax:815-623-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty