Provider Demographics
NPI:1184802761
Name:WACHTEL, AARON THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:THOMAS
Last Name:WACHTEL
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 1:608 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1147
Mailing Address - Country:US
Mailing Address - Phone:309-944-5191
Mailing Address - Fax:
Practice Address - Street 1:608 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1147
Practice Address - Country:US
Practice Address - Phone:309-944-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice