Provider Demographics
NPI:1265655831
Name:RISK, WILLIAM B (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:RISK
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 1:609 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1012
Mailing Address - Country:US
Mailing Address - Phone:765-742-0202
Mailing Address - Fax:765-742-2414
Practice Address - Street 1:609 N 5TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1012
Practice Address - Country:US
Practice Address - Phone:765-742-0202
Practice Address - Fax:765-742-2414
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN61571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice