Provider Demographics
NPI:1295255461
Name:CLEMISHIRE, WILLIAM COBEY (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:COBEY
Last Name:CLEMISHIRE
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 1:145 DORSET LN
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2110
Mailing Address - Country:US
Mailing Address - Phone:918-697-3343
Mailing Address - Fax:
Practice Address - Street 1:210 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2926
Practice Address - Country:US
Practice Address - Phone:217-737-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN266911223G0001X
TX33038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist