Provider Demographics
NPI:1902829377
Name:FLAHERTY, J. WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:WILLIAM
Last Name:FLAHERTY
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 1:417 BILTMORE AVENUE
Mailing Address - Street 2:SUITE 2-C DOCTORS PARK
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4580
Mailing Address - Country:US
Mailing Address - Phone:828-252-3591
Mailing Address - Fax:828-252-7591
Practice Address - Street 1:417 BILTMORE AVE
Practice Address - Street 2:SUITE 2-C DOCTORS PARK
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4543
Practice Address - Country:US
Practice Address - Phone:828-252-3591
Practice Address - Fax:828-252-7591
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992761Medicaid
NC8992761Medicaid