Provider Demographics
NPI:1437205143
Name:KISKER, WILLIAM RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RYAN
Last Name:KISKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1556
Mailing Address - Country:US
Mailing Address - Phone:847-918-0001
Mailing Address - Fax:847-918-8714
Practice Address - Street 1:701 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1556
Practice Address - Country:US
Practice Address - Phone:847-918-0001
Practice Address - Fax:847-918-8714
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice