THERON WAISATH DMD NPI 1144423963

NPI Information

  • NPI: 1144423963
  • Provider Name: THERON WAISATH, DMD
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 3112 VILLAGE OFFICE PL
    CHAMPAIGN, IL
    ZIP 61822
  • Phone: (217) 351-7111

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NPI Details

Theron Waisath, DMD is an oral and maxillofacial surgery dentist in Champaign, IL with 22 years of experience. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. Theron Waisath, DMD NPI is 1144423963. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: SOUTHERN ILLINOIS UNIV SCHOOL OF DENTAL MEDICINE
Graduation Year:2004

The provider's business location address is:

3112 VILLAGE OFFICE PL
CHAMPAIGN, IL
ZIP 61822-680
Phone: (217) 351-7111
Fax: (217) 351-7282

The NPI 1144423963 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/8/2007 and was last updated on 7/23/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1204E00000XOral & Maxillofacial Surgery2422OHIONo
21223S0112XDentistOral and Maxillofacial Surgery019.027879ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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