Provider Demographics
NPI:1417362377
Name:VANDERVOORT, WILLIAM MAURY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MAURY
Last Name:VANDERVOORT
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 1:805 RICE MINE RD N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2314
Mailing Address - Country:US
Mailing Address - Phone:205-345-3400
Mailing Address - Fax:205-345-6555
Practice Address - Street 1:805 RICE MINE RD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2314
Practice Address - Country:US
Practice Address - Phone:205-345-3400
Practice Address - Fax:205-345-6555
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL61031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice