Provider Demographics
NPI:1851483093
Name:QUEEN, WILLIAM F (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:QUEEN
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 1:902 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3545
Mailing Address - Country:US
Mailing Address - Phone:304-263-6568
Mailing Address - Fax:304-267-7183
Practice Address - Street 1:902 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3545
Practice Address - Country:US
Practice Address - Phone:304-263-6568
Practice Address - Fax:304-267-7183
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice