Provider Demographics
NPI:1861558744
Name:PETTY, WILLIAM D (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:PETTY
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:4233 W 95TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2623
Mailing Address - Country:US
Mailing Address - Phone:708-636-2900
Mailing Address - Fax:708-636-3337
Practice Address - Street 1:4233 W 95TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60462
Practice Address - Country:US
Practice Address - Phone:708-636-2900
Practice Address - Fax:708-636-3337
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL019-A143861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics