Provider Demographics
NPI:1639389158
Name:BALTAZAR, WILLIAM C (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:BALTAZAR
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 1:702 W ARAPAHO RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4154
Mailing Address - Country:US
Mailing Address - Phone:972-470-0236
Mailing Address - Fax:972-644-4068
Practice Address - Street 1:702 W ARAPAHO RD
Practice Address - Street 2:SUITE 108
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4154
Practice Address - Country:US
Practice Address - Phone:972-470-0236
Practice Address - Fax:972-644-4068
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19676OtherTX.LIC.NO.