Provider Demographics
NPI:1760578728
Name:STAFFORD, WILLIAM MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:STAFFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:MICHAEL
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5414 PARKCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-454-4539
Mailing Address - Fax:512-454-2479
Practice Address - Street 1:5414 PARKCREST DRIVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-454-4539
Practice Address - Fax:512-454-2479
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX852271OtherUNITED CONCORDIA
TXD09551OtherBLUE CROSS BLUE SHIELD