Provider Demographics
NPI:1033776158
Name:BEHLKE, WILLIAM J JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:BEHLKE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 E 3900 S STE 116
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4407
Mailing Address - Country:US
Mailing Address - Phone:801-278-4223
Mailing Address - Fax:
Practice Address - Street 1:11 SUNSET WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2333
Practice Address - Country:US
Practice Address - Phone:440-479-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT117859421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty