Provider Demographics
NPI:1205953502
Name:BOAK, WILLIAM BRYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRYAN
Last Name:BOAK
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 1:1910 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1880
Mailing Address - Country:US
Mailing Address - Phone:412-381-3373
Mailing Address - Fax:412-381-2829
Practice Address - Street 1:1910 E CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1880
Practice Address - Country:US
Practice Address - Phone:412-381-3373
Practice Address - Fax:412-381-2829
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025414L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice