Provider Demographics
NPI:1699829531
Name:PRIVETT, WILLIAM ESTAL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ESTAL
Last Name:PRIVETT
Suffix:JR
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 1:1111 ROCK PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8344
Mailing Address - Country:US
Mailing Address - Phone:979-775-7777
Mailing Address - Fax:979-764-5689
Practice Address - Street 1:1111 ROCK PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8344
Practice Address - Country:US
Practice Address - Phone:979-775-7777
Practice Address - Fax:979-764-5689
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice