Provider Demographics
NPI:1033249859
Name:JESENOVEC, WILLIAM L (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:JESENOVEC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S LEWIS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-6100
Mailing Address - Country:US
Mailing Address - Phone:847-336-9033
Mailing Address - Fax:847-336-9093
Practice Address - Street 1:700 S LEWIS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-6100
Practice Address - Country:US
Practice Address - Phone:847-336-9033
Practice Address - Fax:847-336-9093
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice