Provider Demographics
NPI:1700202116
Name:WILLIAM R. PLASTER, DDS, PA
Entity Type:Organization
Organization Name:WILLIAM R. PLASTER, DDS, PA
Other - Org Name:PLASTER FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:PLASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-487-7391
Mailing Address - Street 1:1455 E MARION ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4985
Mailing Address - Country:US
Mailing Address - Phone:704-487-7391
Mailing Address - Fax:
Practice Address - Street 1:1455 E MARION ST
Practice Address - Street 2:SUITE F
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4985
Practice Address - Country:US
Practice Address - Phone:704-487-7391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC6712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899014PMedicaid