Provider Demographics
NPI:1780725002
Name:ESTEVEZ, WILLIAM (DENTIST)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:ESTEVEZ
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FAIRVIEW AVE APT 7I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2755
Mailing Address - Country:US
Mailing Address - Phone:212-567-6776
Mailing Address - Fax:
Practice Address - Street 1:629 W 173RD ST SUITE 2G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1421
Practice Address - Country:US
Practice Address - Phone:212-923-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0462951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice