1568424000 NPI number — MR. WILLIAM C DEAK DDS

Table of content: MR. WILLIAM C DEAK DDS (NPI 1568424000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568424000 NPI number — MR. WILLIAM C DEAK DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEAK
Provider First Name:
WILLIAM
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568424000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 NORTH ABBE ROAD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
ELURIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-366-3325
Provider Business Mailing Address Fax Number:
440-366-6611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 N ABBE RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ELYRIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44035-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-366-3325
Provider Business Practice Location Address Fax Number:
440-366-6611
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  015418 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0409043 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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