Provider Demographics
NPI:1568424000
Name:DEAK, WILLIAM C (DDS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:DEAK
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 1:1212 NORTH ABBE ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ELURIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035
Mailing Address - Country:US
Mailing Address - Phone:440-366-3325
Mailing Address - Fax:440-366-6611
Practice Address - Street 1:1212 N ABBE RD
Practice Address - Street 2:SUITE D
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1600
Practice Address - Country:US
Practice Address - Phone:440-366-3325
Practice Address - Fax:440-366-6611
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0154181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0409043Medicaid