Provider Demographics
NPI:1669495016
Name:DUPONT, WILLIAM M (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:DUPONT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:M
Other - Last Name:DUPONT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:505 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-3140
Mailing Address - Country:US
Mailing Address - Phone:413-420-2222
Mailing Address - Fax:413-592-2324
Practice Address - Street 1:505 FRONT ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-3140
Practice Address - Country:US
Practice Address - Phone:413-420-2222
Practice Address - Fax:413-592-2324
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0210765Medicaid