Provider Demographics
NPI:1114096351
Name:ALTHOFF, WILLIAM CHARLES (WILLIAM ALTHOFF)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:ALTHOFF
Suffix:
Gender:M
Credentials:WILLIAM ALTHOFF
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:CHARLES
Other - Last Name:ALTHOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:176 E DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3033
Mailing Address - Country:US
Mailing Address - Phone:847-459-5890
Mailing Address - Fax:847-459-5897
Practice Address - Street 1:176 E DUNDEE RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3033
Practice Address - Country:US
Practice Address - Phone:847-459-5890
Practice Address - Fax:847-459-5897
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist