Provider Demographics
NPI:1205962313
Name:FARICELLIE, WILLIAM JOSEPH III (DMD,MS,BA)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:FARICELLIE
Suffix:III
Gender:M
Credentials:DMD,MS,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 N FRENCH RD
Mailing Address - Street 2:STE. # 3
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2104
Mailing Address - Country:US
Mailing Address - Phone:716-691-8042
Mailing Address - Fax:
Practice Address - Street 1:656 N FRENCH RD
Practice Address - Street 2:STE. # 3
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2104
Practice Address - Country:US
Practice Address - Phone:716-691-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0406221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice