Provider Demographics
NPI:1720182728
Name:BOOTH, WILLIAM DYER (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DYER
Last Name:BOOTH
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:PO BOX 948
Mailing Address - Street 2:1227 W MISSOURI ST
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622-0948
Mailing Address - Country:US
Mailing Address - Phone:417-345-2101
Mailing Address - Fax:417-345-2101
Practice Address - Street 1:1227 W MISSOURI ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622-0948
Practice Address - Country:US
Practice Address - Phone:417-345-2101
Practice Address - Fax:417-345-2101
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO13454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist