Theron Waisath
Oral and Maxillofacial Surgeon Oral & Maxillofacial Surgeon
3112 Village Office Pl
Champaign
, Illinois 61822-7680
Theron Waisath
Oral and Maxillofacial Surgeon Oral & Maxillofacial Surgeon
3112 Village Office Pl
Champaign
, Illinois 61822-7680
(217) 351-7282
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About
Features
Specialties
- Oral and Maxillofacial Surgeon
- Oral & Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Theron Waisath
- 3112 Village Office Pl
- Champaign, IL
- Zip : 61822-7680
- Fax : (217) 351-7282
- Phone : (217) 351-7111
Second Address
- Theron Waisath
- 3112 Village Office Pl
- Champaign, IL
- Zip : 61822-7680
- Fax : (217) 351-7282
- Phone : (217) 351-7111
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FAQs
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Is Theron Waisath a sole practitioner?
Is Theron Waisath accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223S0112X | Oral and Maxillofacial Surgeon | 019.027879 | IL |
| N | 204E00000X | Oral & Maxillofacial Surgeon | 2422 | OH |
National Provider Identifier
| NPI | 1144423963 |
|---|---|
| Provider Name | Theron Waisath |
| First Address | Champaign, IL 61822-7680 |
| Second Address | Champaign, IL 61822-7680 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 08/06/2007 |
| Last Update Date | 23/07/2009 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.