Provider Demographics
NPI:1871696922
Name:FLICK, WILLIAM GUSTAV (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GUSTAV
Last Name:FLICK
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 1:6305 W 95TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2255
Mailing Address - Country:US
Mailing Address - Phone:708-425-4300
Mailing Address - Fax:708-425-4310
Practice Address - Street 1:6305 W 95TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2255
Practice Address - Country:US
Practice Address - Phone:708-425-4300
Practice Address - Fax:708-425-4310
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0148391223S0112X
IL1370000091223S0112X, 204E00000X
IL021001050204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0040121107OtherBLUE CROSS BLUE SHIELD
IL0091640652OtherBLUE CROSS BLUE SHIELD
IL0091640653OtherBLUE CROSS BLUE SHIELD
ILT36657Medicare UPIN
ILP15892Medicare ID - Type Unspecified