Provider Demographics
NPI:1235192303
Name:VERAX III, WILLIAM JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:VERAX III
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 1:211 W SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41040-1158
Mailing Address - Country:US
Mailing Address - Phone:859-654-5041
Mailing Address - Fax:859-654-4186
Practice Address - Street 1:211 W SHELBY ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040-1158
Practice Address - Country:US
Practice Address - Phone:859-654-5041
Practice Address - Fax:859-654-4186
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60052461Medicaid