Provider Demographics
NPI:1063677144
Name:WAKERLIN, WARREN F (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:F
Last Name:WAKERLIN
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5087
Mailing Address - Country:US
Mailing Address - Phone:630-682-3050
Mailing Address - Fax:630-682-9738
Practice Address - Street 1:610 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5087
Practice Address - Country:US
Practice Address - Phone:630-682-3050
Practice Address - Fax:630-682-9738
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-A-135401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics