Waisath, Theron

Waisath, Theron is an sole proprietor health care provider with primary practice located at 3112 Village Office Pl , Champaign IL 61822-7680. He recently has 2 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is his primary health care specialty. Waisath, Theron can be contacted via phone (217) 351-7111.

Contact Information

Primary practice address
3112 Village Office Pl Champaign IL 61822-7680
Phone: (217) 351-7111
Fax: (217) 351-7282
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 019.027879 Illinois
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 2422 Ohio

Profile Details

NPI number 1144423963
LBN Legal business name Waisath, Theron
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 8th, 2007
Last updated Jul 23rd, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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