Provider Demographics
NPI:1992708978
Name:SLAVIN, WILLIAM HENRY IV (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HENRY
Last Name:SLAVIN
Suffix:IV
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 1:1 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1534
Mailing Address - Country:US
Mailing Address - Phone:815-468-8832
Mailing Address - Fax:815-468-8862
Practice Address - Street 1:1 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1534
Practice Address - Country:US
Practice Address - Phone:815-468-8832
Practice Address - Fax:815-468-8862
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice