Healthcare Provider Details

I. General information

NPI: 1114191335
Provider Name (Legal Business Name): WILLIAM MATHURIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7351 W OAKLAND PARK BLVD STE 102
TAMARAC FL
33319-7107
US

IV. Provider business mailing address

5521 S GALVEZ ST
NEW ORLEANS LA
70125-4703
US

V. Phone/Fax

Practice location:
  • Phone: 954-742-5055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN14622
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5750
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: