Provider Demographics
NPI:1043256308
Name:SERGAKIS, WILLIAM MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:SERGAKIS
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 1:7240 HIGHLAND DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5532
Mailing Address - Country:US
Mailing Address - Phone:801-733-0864
Mailing Address - Fax:801-733-4920
Practice Address - Street 1:7240 HIGHLAND DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-5532
Practice Address - Country:US
Practice Address - Phone:801-733-0864
Practice Address - Fax:801-733-4920
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT88-143937-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice