Healthcare Provider Details

I. General information

NPI: 1891908737
Provider Name (Legal Business Name): WILLIAM G ABBOTT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S PAULINA ST COLLEGE OF DENTISTRY
CHICAGO IL
60612-7210
US

IV. Provider business mailing address

220 OXFORD STREET WEST
LONDON ONTARIO
N6H 1S4
CA

V. Phone/Fax

Practice location:
  • Phone: 312-996-7493
  • Fax:
Mailing address:
  • Phone: 519-433-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: