Provider Demographics
NPI:1154519882
Name:KAO, WILLIAM C (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:KAO
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 1:1150 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3385
Mailing Address - Country:US
Mailing Address - Phone:630-529-0600
Mailing Address - Fax:630-529-5305
Practice Address - Street 1:1150 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-3385
Practice Address - Country:US
Practice Address - Phone:630-529-0600
Practice Address - Fax:630-529-5305
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190164381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice