Provider Demographics
NPI:1659665883
Name:EADES, WILLIAM BRYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRYAN
Last Name:EADES
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 1:132 EAST MAIN CROSS STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-8780
Mailing Address - Country:US
Mailing Address - Phone:270-338-2532
Mailing Address - Fax:270-641-0237
Practice Address - Street 1:132 EAST MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-8780
Practice Address - Country:US
Practice Address - Phone:270-338-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice