Provider Demographics
NPI:1235127812
Name:MOSEMAN, WILLAIM DOUGLAS
Entity Type:Individual
Prefix:DR
First Name:WILLAIM
Middle Name:DOUGLAS
Last Name:MOSEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-1853
Mailing Address - Country:US
Mailing Address - Phone:402-296-2188
Mailing Address - Fax:402-296-4480
Practice Address - Street 1:619 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-1853
Practice Address - Country:US
Practice Address - Phone:402-296-2188
Practice Address - Fax:402-296-4480
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE50511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice