Provider Demographics
NPI:1083877971
Name:WASH, KARL ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:ALAN
Last Name:WASH
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 1:545 S YORK RD
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3000
Mailing Address - Country:US
Mailing Address - Phone:630-766-0115
Mailing Address - Fax:630-766-1164
Practice Address - Street 1:545 S YORK RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3000
Practice Address - Country:US
Practice Address - Phone:630-766-0115
Practice Address - Fax:630-766-1164
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015010122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist