Provider Demographics
NPI:1245211200
Name:WAX, WILLIAM URI (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:URI
Last Name:WAX
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 1:7900 N. MILWAUKEE AVE
Mailing Address - Street 2:SUITE 2-24
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-470-0240
Mailing Address - Fax:847-470-2014
Practice Address - Street 1:7900 N. MILWAUKEE AVE
Practice Address - Street 2:SUITE 2-24
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-470-0240
Practice Address - Fax:847-470-2014
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019011169122300000X
IL019-011169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL102647Medicaid