Provider Demographics
NPI:1245240480
Name:MULDOON, WILLIAM P (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:MULDOON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:19910 NORTHCOVE RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6447
Mailing Address - Country:US
Mailing Address - Phone:704-892-1198
Mailing Address - Fax:704-892-4119
Practice Address - Street 1:19910 NORTHCOVE RD
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6447
Practice Address - Country:US
Practice Address - Phone:704-892-1198
Practice Address - Fax:704-892-4119
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT90859Medicare UPIN