Healthcare Provider Details

I. General information

NPI: 1285706499
Provider Name (Legal Business Name): WILLIAM A. CAUDILL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HARDIN LN SUITE A
SOMERSET KY
42503-3812
US

IV. Provider business mailing address

100 HARDIN LN SUITE A
SOMERSET KY
42503-3812
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-8359
  • Fax: 606-679-8350
Mailing address:
  • Phone: 606-679-8359
  • Fax: 606-679-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4733
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: