Healthcare Provider Details

I. General information

NPI: 1982942157
Provider Name (Legal Business Name): NATURE COAST ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7391 COMMERCIAL WAY
WEEKI WACHEE FL
34613-5200
US

IV. Provider business mailing address

7391 COMMERCIAL WAY
WEEKI WACHEE FL
34613-5200
US

V. Phone/Fax

Practice location:
  • Phone: 352-592-3636
  • Fax: 352-592-3973
Mailing address:
  • Phone: 352-592-3636
  • Fax: 352-592-3973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number16231
License Number StateFL

VIII. Authorized Official

Name: NICHOLAS WILLIAMS
Title or Position: DENTIST
Credential: DDS
Phone: 352-592-3636