Provider Demographics
NPI:1154326569
Name:NANTZ, WILLIAM STEWART (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STEWART
Last Name:NANTZ
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 1:6790 PHELAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5968
Mailing Address - Country:US
Mailing Address - Phone:409-866-7498
Mailing Address - Fax:409-866-7324
Practice Address - Street 1:6790 PHELAN BLVD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5968
Practice Address - Country:US
Practice Address - Phone:409-866-7498
Practice Address - Fax:409-866-7324
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL1508OtherBLUE CROSS/BLUE SHIELD
689351OtherUNITED CONCORDIA