Individual
DR. ALAN J. NIDETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4905 OLD ORCHARD CTR, SUITE 420, SKOKIE, IL 60077-1458
(847) 673-9292
(847) 674-4696
Mailing address
4905 OLD ORCHARD CTR, SUITE 420, SKOKIE, IL 60077-1458
(847) 673-9292
(847) 674-4696
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.017653
IL
1223G0001X
General Practice Dentistry
019.020212
IL
Other
Enumeration date
04/18/2011
Last updated
04/18/2011
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