Provider Demographics
NPI:1134136500
Name:POWLEY, WILLIAM BRIAN (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRIAN
Last Name:POWLEY
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 1:10565 N TATUM BLVD
Mailing Address - Street 2:STE B-111
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1095
Mailing Address - Country:US
Mailing Address - Phone:480-443-1100
Mailing Address - Fax:480-443-8820
Practice Address - Street 1:10565 N TATUM BLVD
Practice Address - Street 2:STE B-111
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1095
Practice Address - Country:US
Practice Address - Phone:480-443-1100
Practice Address - Fax:480-443-8820
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice