Provider Demographics
NPI:1467618173
Name:WILLIAM D HANCOCK JR DDS SC
Entity Type:Organization
Organization Name:WILLIAM D HANCOCK JR DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-351-6699
Mailing Address - Street 1:109 FAIRFIELD WAY
Mailing Address - Street 2:204
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1583
Mailing Address - Country:US
Mailing Address - Phone:630-351-6699
Mailing Address - Fax:
Practice Address - Street 1:109 FAIRFIELD WAY
Practice Address - Street 2:204
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1583
Practice Address - Country:US
Practice Address - Phone:630-351-6699
Practice Address - Fax:630-351-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty