Provider Demographics
NPI:1528176492
Name:ONDERAK, JOHN GERARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GERARD
Last Name:ONDERAK
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 1:1215 CRANSTON RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2534
Mailing Address - Country:US
Mailing Address - Phone:608-363-9400
Mailing Address - Fax:608-363-9837
Practice Address - Street 1:1215 CRANSTON RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2534
Practice Address - Country:US
Practice Address - Phone:608-363-9400
Practice Address - Fax:608-363-9837
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice