Healthcare Provider Details

I. General information

NPI: 1487817615
Provider Name (Legal Business Name): WILLIAM E SACK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BURLINGTON AVE
DOWNERS GROVE IL
60515-5127
US

IV. Provider business mailing address

425 BURLINGTON AVE
DOWNERS GROVE IL
60515-5127
US

V. Phone/Fax

Practice location:
  • Phone: 630-968-5900
  • Fax: 630-968-5901
Mailing address:
  • Phone: 630-968-5900
  • Fax: 630-968-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019018088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: