Provider Demographics
NPI:1558665281
Name:VACHON, WIL (DMD)
Entity Type:Individual
Prefix:
First Name:WIL
Middle Name:
Last Name:VACHON
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 1:31 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2537
Mailing Address - Country:US
Mailing Address - Phone:207-443-6234
Mailing Address - Fax:207-443-6235
Practice Address - Street 1:31 UNION ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2537
Practice Address - Country:US
Practice Address - Phone:207-443-6234
Practice Address - Fax:207-443-6235
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME25111223G0001X
PADS0410621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice