Provider Demographics
NPI:1023053667
Name:RAST, JR, WILLIAM C (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:RAST, JR
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 1:5724 VISTA LINDA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-3034
Mailing Address - Country:US
Mailing Address - Phone:915-584-0379
Mailing Address - Fax:915-581-4184
Practice Address - Street 1:7211 N MESA ST
Practice Address - Street 2:SUITE 1 SOUTH
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3611
Practice Address - Country:US
Practice Address - Phone:915-581-7800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery