Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 19-A-13540 | IL |
NPI | 1063677144 |
---|---|
Provider Name | Dr. Warren F. Wakerlin |
First Address | Wheaton, IL 60187-5087 |
Second Address | Wheaton, IL 60187-5087 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 28/07/2008 |