Provider Demographics
NPI:1548787328
Name:AARON THOMAS WACHTEL, DDS
Entity Type:Organization
Organization Name:AARON THOMAS WACHTEL, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WACHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-944-5191
Mailing Address - Street 1:108 WEST 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:PROPHETSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:61277
Mailing Address - Country:US
Mailing Address - Phone:815-537-5410
Mailing Address - Fax:309-944-8317
Practice Address - Street 1:108 WEST 3RD STREET
Practice Address - Street 2:
Practice Address - City:PROPHETSTOWN
Practice Address - State:IL
Practice Address - Zip Code:61277
Practice Address - Country:US
Practice Address - Phone:815-537-5410
Practice Address - Fax:309-944-8317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty