Provider Demographics
NPI:1790719169
Name:DUNCAN, WILLIAM KEITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KEITH
Last Name:DUNCAN
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 1:2500 N. STATE ST
Mailing Address - Street 2:PEDIATRIC DENTISTRY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-6100
Mailing Address - Fax:601-984-6103
Practice Address - Street 1:2500 N. STATE ST
Practice Address - Street 2:PEDIATRIC DENTISTRY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-6100
Practice Address - Fax:601-984-6103
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2174-851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060104Medicaid