Healthcare Provider Details

I. General information

NPI: 1659665883
Provider Name (Legal Business Name): WILLIAM BRYAN EADES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 EAST MAIN CROSS ST
GREENVILLE KY
42345-8780
US

IV. Provider business mailing address

132 EAST MAIN CROSS STREET
GREENVILLE KY
42345-8780
US

V. Phone/Fax

Practice location:
  • Phone: 270-338-2532
  • Fax:
Mailing address:
  • Phone: 270-338-2532
  • Fax: 270-641-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9051
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: