Provider Demographics
NPI:1811933575
Name:MEHAN, WILLIAM A (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:MEHAN
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 1:113 MAMMOTH RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4337
Mailing Address - Country:US
Mailing Address - Phone:603-623-8003
Mailing Address - Fax:603-623-1191
Practice Address - Street 1:113 MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4337
Practice Address - Country:US
Practice Address - Phone:603-623-8003
Practice Address - Fax:603-623-1191
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics