THERON WAISATH, DMD

Dentist - Oral and Maxillofacial Surgery

Active Individual
NPI: 1144423963

Practice Address

3112 VILLAGE OFFICE PL
Champaign, IL 61822

Phone: (217) 351-7111

Specialties

Specialty Code Primary License
Dentist - Oral and Maxillofacial Surgery 1223S0112X Yes 019.027879 (IL)
Oral & Maxillofacial Surgery 204E00000X No 2422 (OH)

Frequently Asked Questions

NPI 1144423963 is the National Provider Identifier for THERON WAISATH, DMD, a Dentist - Oral and Maxillofacial Surgery provider located in Champaign, IL. This NPI was enumerated on June 8, 2007.
THERON WAISATH, DMD practices at 3112 VILLAGE OFFICE PL, Champaign, IL 61822.

Quick Facts

NPI
1144423963
Type
Individual
Enumerated
Jun 8, 2007
Last Updated
Jul 23, 2009

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