Provider Demographics
NPI:1902926330
Name:NUDERA ORTHODONTICS
Entity Type:Organization
Organization Name:NUDERA ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:NUDERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:847-760-6353
Mailing Address - Street 1:81 S. MCLEAN BLVD., UNIT B
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177
Mailing Address - Country:US
Mailing Address - Phone:847-760-6353
Mailing Address - Fax:847-760-6356
Practice Address - Street 1:81 S. MCLEAN BLVD., UNIT B
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL600093371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty