Provider Demographics
NPI:1780657221
Name:ANDERSON, WILLIAM HART III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HART
Last Name:ANDERSON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:135 W NEWBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5645
Mailing Address - Country:US
Mailing Address - Phone:184-768-8242
Mailing Address - Fax:184-768-8440
Practice Address - Street 1:3001 6TH ST
Practice Address - Street 2:NAVAL HOSPITAL, DENTAL DIRECTORATE
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2833
Practice Address - Country:US
Practice Address - Phone:184-768-8242
Practice Address - Fax:184-768-8440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA200841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery