Provider Demographics
NPI:1750785200
Name:DILES, WILLIAM SAMUEL III
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SAMUEL
Last Name:DILES
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MISSION CIRCLE #105
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5369
Mailing Address - Country:US
Mailing Address - Phone:707-538-1000
Mailing Address - Fax:707-538-1013
Practice Address - Street 1:55 MISSION CIRCLE #105
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5369
Practice Address - Country:US
Practice Address - Phone:707-538-1000
Practice Address - Fax:707-538-1013
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7822237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist