Healthcare Provider Details

I. General information

NPI: 1841351376
Provider Name (Legal Business Name): WILLIAM WARNER FAY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/01/2021
Certification Date: 08/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 FILLMORE ST APT 301
SAN FRANCISCO CA
94123-2158
US

IV. Provider business mailing address

3501 FILLMORE ST APT 301208
SAN FRANCISCO CA
94123-2169
US

V. Phone/Fax

Practice location:
  • Phone: 415-994-1188
  • Fax: 650-742-9704
Mailing address:
  • Phone: 415-994-1188
  • Fax: 650-742-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS22456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: