Provider Demographics
NPI:1619000254
Name:DORNE, WILLIAM PADGE
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PADGE
Last Name:DORNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CYPRESS POINT PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164
Mailing Address - Country:US
Mailing Address - Phone:386-445-6677
Mailing Address - Fax:
Practice Address - Street 1:105 CYPRESS POINT PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164
Practice Address - Country:US
Practice Address - Phone:386-445-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice