Provider Demographics
NPI:1902021660
Name:SIVLEY, WILLIAM MARK (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
Last Name:SIVLEY
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 1:3409 S 14TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4956
Mailing Address - Country:US
Mailing Address - Phone:325-692-1580
Mailing Address - Fax:325-692-4865
Practice Address - Street 1:3409 S 14TH ST STE 110
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4956
Practice Address - Country:US
Practice Address - Phone:325-692-1580
Practice Address - Fax:325-692-4865
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist