Provider Demographics
NPI:1114970662
Name:VEAZEY, WILLIAM S (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:VEAZEY
Suffix:
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 1:2626 W STATE ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1858
Mailing Address - Country:US
Mailing Address - Phone:716-379-8155
Mailing Address - Fax:716-379-8252
Practice Address - Street 1:2626 W STATE ST
Practice Address - Street 2:SUITE 211
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1858
Practice Address - Country:US
Practice Address - Phone:716-379-8155
Practice Address - Fax:716-379-8252
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0Medicaid
NY0Medicaid