Provider Demographics
NPI:1922199579
Name:JAKAVICK, WILLIAM LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LAWRENCE
Last Name:JAKAVICK
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 1:380 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4525
Mailing Address - Country:US
Mailing Address - Phone:215-675-2045
Mailing Address - Fax:215-675-7503
Practice Address - Street 1:380 YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4525
Practice Address - Country:US
Practice Address - Phone:215-675-2045
Practice Address - Fax:215-675-7503
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024112L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice