Provider Demographics
NPI:1730339300
Name:WILLERMAN, JAMES KURT (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KURT
Last Name:WILLERMAN
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 1:30 N. MICHIGAN AVENUE
Mailing Address - Street 2:JAMES. K. WILLERMAN DDS SUITE #603
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-346-5661
Mailing Address - Fax:312-346-5681
Practice Address - Street 1:30 N. MICHIGAN AVENUE
Practice Address - Street 2:JAMES. K. WILLERMAN DDS SUITE #603
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-346-5661
Practice Address - Fax:312-346-5681
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.019796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist