Provider Demographics
NPI:1295997807
Name:PACK, WILLIAM ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:PACK
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 1:3001 W ILLINOIS AVE
Mailing Address - Street 2:SUITE 1B1
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3180
Mailing Address - Country:US
Mailing Address - Phone:432-689-2006
Mailing Address - Fax:
Practice Address - Street 1:3001 W ILLINOIS AVE
Practice Address - Street 2:SUITE 1B1
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3180
Practice Address - Country:US
Practice Address - Phone:432-689-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263901223E0200X
NC90091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics