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General NPI Number Information
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NPI Number | 1073643052
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Entity Type | Individual
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Provider Name | WILLIAM L BACON DDS
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 310 S GREENLEAF ST STE 201
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City | GURNEE
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State | IL
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Zip | 60031-5708
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Country | US
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Telephone | 847-623-5530
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Fax |
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Provider Business Mailing Address
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Address Line | 310 S GREENLEAF ST STE 201
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City | GURNEE
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State | IL
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Zip | 60031-5708
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Country | US
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Telephone | 847-623-5530
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Fax | 630-832-6041
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 01925841
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 102891
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License Number State | WI
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