Provider Demographics
NPI:1508901000
Name:TEDFORD, WILLIAM T (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:TEDFORD
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 1:3620 N FREMONT ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4348
Mailing Address - Country:US
Mailing Address - Phone:773-388-2253
Mailing Address - Fax:773-728-9208
Practice Address - Street 1:5419 N SHERIDAN RD
Practice Address - Street 2:STE.105
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1964
Practice Address - Country:US
Practice Address - Phone:773-728-9200
Practice Address - Fax:773-728-9208
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice