Provider Demographics
NPI:1053414409
Name:WILLIAM J WADDELL DDS
Entity type:Organization
Organization Name:WILLIAM J WADDELL DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-764-1013
Mailing Address - Street 1:9973 SAWMILL PARKWAY
Mailing Address - Street 2:C
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7571
Mailing Address - Country:US
Mailing Address - Phone:614-764-1013
Mailing Address - Fax:614-764-0174
Practice Address - Street 1:9973 SAWMILL PARKWAY
Practice Address - Street 2:C
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7571
Practice Address - Country:US
Practice Address - Phone:614-764-1013
Practice Address - Fax:614-764-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty