Provider Demographics
NPI:1881949923
Name:TRAHAN, WILLIAM R (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:TRAHAN
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N CROSS ST
Mailing Address - Street 2:APT 642
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5323
Mailing Address - Country:US
Mailing Address - Phone:802-338-2061
Mailing Address - Fax:
Practice Address - Street 1:525 TYLER RD
Practice Address - Street 2:SUITE E
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3305
Practice Address - Country:US
Practice Address - Phone:630-377-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030154122300000X
IL021.0026981223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist