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General NPI Number Information
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NPI Number | 1629477062
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Entity Type | Organization
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Legal Business Name | WILLIAM L. BACON, D.D.S., LTD.
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 332 N YORK ST
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City | ELMHURST
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State | IL
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Zip | 60126-2318
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Country | US
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Telephone | 630-832-1212
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Fax | 630-504-2208
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Provider Business Mailing Address
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Address Line | 332 N YORK ST
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City | ELMHURST
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State | IL
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Zip | 60126-2318
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Country | US
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Telephone | 630-832-1212
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Fax | 630-504-2208
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. WILLIAM L. BACON
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Credential | D.D.S.
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Telephone | 630-832-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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