Provider Demographics
NPI:1629288261
Name:SHRINER, WILLIAM NOLAN (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:NOLAN
Last Name:SHRINER
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 1:603 LAKE BLUE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-6980
Mailing Address - Country:US
Mailing Address - Phone:863-465-2867
Mailing Address - Fax:
Practice Address - Street 1:408 W INTERLAKE BLVD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-0700
Practice Address - Country:US
Practice Address - Phone:863-465-2037
Practice Address - Fax:863-465-1155
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN53261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice