Provider Demographics
NPI:1003099482
Name:MOORKAMP, WILLIAM BERNARD III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BERNARD
Last Name:MOORKAMP
Suffix:III
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 1:912 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3350
Mailing Address - Country:US
Mailing Address - Phone:573-364-1345
Mailing Address - Fax:573-364-4764
Practice Address - Street 1:912 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3350
Practice Address - Country:US
Practice Address - Phone:573-364-1345
Practice Address - Fax:573-364-4764
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist