Provider Demographics
NPI:1073643052
Name:BACON, WILLIAM L (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:BACON
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 1:310 S GREENLEAF ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5708
Mailing Address - Country:US
Mailing Address - Phone:847-623-5530
Mailing Address - Fax:630-832-6041
Practice Address - Street 1:310 S GREENLEAF ST STE 201
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5708
Practice Address - Country:US
Practice Address - Phone:847-623-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01925841122300000X
WI102891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist