Provider Demographics
NPI:1427109404
Name:TODD, WILLIAM M (DMD, MSD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:TODD
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 1:106 AIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5841
Mailing Address - Country:US
Mailing Address - Phone:618-993-5554
Mailing Address - Fax:618-993-0141
Practice Address - Street 1:106 AIRWAY DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5841
Practice Address - Country:US
Practice Address - Phone:618-993-5554
Practice Address - Fax:618-993-0141
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics