Provider Demographics
NPI:1598838195
Name:MOONEY, WILLIAM KYLE (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KYLE
Last Name:MOONEY
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 1:416 ROOSEVELT HWY
Mailing Address - Street 2:STE #201
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446
Mailing Address - Country:US
Mailing Address - Phone:802-655-4614
Mailing Address - Fax:802-654-7443
Practice Address - Street 1:416 ROOSEVELT HWY
Practice Address - Street 2:SUITE #201
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-655-4614
Practice Address - Fax:802-655-4614
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600008831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice