Provider Demographics
NPI:1275697666
Name:VESELY, WILLIAM CURTIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CURTIS
Last Name:VESELY
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 1:111 E MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4801
Mailing Address - Country:US
Mailing Address - Phone:815-433-3996
Mailing Address - Fax:815-433-6955
Practice Address - Street 1:111 E MCKINLEY RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4801
Practice Address - Country:US
Practice Address - Phone:815-433-3996
Practice Address - Fax:815-433-6955
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101738Medicaid