Provider Demographics
NPI:1962560821
Name:JANECKE, MARTIN GERARD (DDS)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:GERARD
Last Name:JANECKE
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 1:727 MAIN ST PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:PECATONICA
Mailing Address - State:IL
Mailing Address - Zip Code:61063-0608
Mailing Address - Country:US
Mailing Address - Phone:815-239-1313
Mailing Address - Fax:815-239-9014
Practice Address - Street 1:727 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECATONICA
Practice Address - State:IL
Practice Address - Zip Code:61063-0608
Practice Address - Country:US
Practice Address - Phone:815-239-1313
Practice Address - Fax:815-239-9014
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist