Provider Demographics
NPI:1912033309
Name:MA, WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4397 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6253
Mailing Address - Country:US
Mailing Address - Phone:561-622-8013
Mailing Address - Fax:561-622-5874
Practice Address - Street 1:4397 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6253
Practice Address - Country:US
Practice Address - Phone:561-622-8013
Practice Address - Fax:561-622-5874
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00143301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice