Provider Demographics
NPI:1922161355
Name:CONKLIN, WILLIAM T (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:CONKLIN
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 1:9025 OLD REDWOOD HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8881
Mailing Address - Country:US
Mailing Address - Phone:707-838-3363
Mailing Address - Fax:707-838-4995
Practice Address - Street 1:9025 OLD REDWOOD HWY
Practice Address - Street 2:SUITE A
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-8881
Practice Address - Country:US
Practice Address - Phone:707-838-3363
Practice Address - Fax:707-838-4995
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist