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Search › Illinois › 1223S0112X

Theron Waisath, DMD

NPI 1144423963 · on the registry since 2007 · sole proprietor

Practice

Address
3112 Village Office Pl
Champaign, IL 61822
Phone
(217) 351-7111
Fax
(217) 351-7282
Organisation at this address
Affiliates In Oral & Maxillofacial Surgery Ltd
Inferred from a shared address, not stated in the registry.

Registry record

Primary taxonomy
1223S0112X
1223S0112X
Also registered as
204E00000X
Licence states on file
IL, OH
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2009-07-23

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois