Jack Christopher Amram, DDS
Individual provider Active NPI Dentist · Crete, IL
NPI 1326291998 · NPPES record last updated Oct 28, 2008
Key facts
- NPI
- 1326291998
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 16487 (IL)
- Practice address
- 1285 Main Street
Crete, IL 60417 - Phone
- (708) 672-0772
- Fax
- (708) 672-0089
- NPI assigned
- Oct 28, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16487 | IL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 16487 | IL | Yes |
Addresses
Primary practice location
1285 Main Street
Crete, IL 60417
Mailing address
1285 Main Street
Crete, IL 60417
Phone (708) 672-0772
Other providers in Crete, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.