Theron Waisath
DMD | Oral and Maxillofacial Surgeon | 22+ years Exp
3112 Village Office Pl, Champaign
Illinois, 61822-7680
217-351-7111 217-351-7282
Maps & DirectionsTheron Waisath is a Champaign, Illinois based Oral and Maxillofacial Surgeon with
22 years of experience in
Oral and Maxillofacial Surgery. He completed his graduation from
Southern Illinois Univ School Of Dental Medicine in 2004. He accepts the Medicare-approved amount. Patients will not be billed for any more than the Medicare deductible and coinsurance. Active license number of Theron Waisath is
019.027879 for Oral and Maxillofacial Surgery in Illinois. His current practice location is
3112 Village Office Pl, Champaign. Patients can reach him at
217-351-7111.
Theron Waisath deals with 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.
Complete Profile:
Theron Waisath speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
| Name: | Theron Waisath |
| Specialization: | Oral and Maxillofacial Surgeon |
| Gender: | Male |
| Credentials: | DMD |
| Experience: | 22+ years |
| Medical School Attended: | Southern Illinois Univ School Of Dental Medicine |
| Graduation Year: | 2004 |
| Accepts Medicare Assignment: | Yes |
| Practice Address: | 3112 Village Office Pl, Champaign,
Illinois, 61822-7680 |
| Phone: | 217-351-7111 |
| Fax: | 217-351-7282 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
| PAC ID: | 0446433759 |
| Enrollment ID: | I20110324000222 |
| NPI Number: | 1144423963 |
| NPI Enumeration Date: | 08 Jun, 2007 |
| NPI Last Update On: | 23 Jul, 2009 |
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Theron Waisath are as mentioned below.
| License Number | Specialization | State | Status | |
| 019.027879 | Oral and Maxillofacial Surgery | Illinois | Primary | |
| 2422 | Oral & Maxillofacial Surgery | Ohio | Secondary | |
Group Practice:
Group practices are practice of medicine by a group of physicians who share their premises and other resources. Following list states all the group name
with which Theron Waisath is associated with along with the number of members in that group.
| Organization Name (Group PAC ID) | Members |
| Affiliates In Oral And Maxillofacial Surgery Ltd (0345309779) | 2 |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 3112 Village Office Pl,
Champaign, Illinois |
| Zip: | 61822-7680 |
| Phone Number: | 217-351-7111 |
| Fax Number: | 217-351-7282 |
Patients can reach Theron Waisath at
3112 Village Office Pl, Champaign, Illinois or can
call to book an appointment on 217-351-7111.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.