Healthcare Provider Details

I. General information

NPI: 1023258530
Provider Name (Legal Business Name): WILLIAM HERRICK WAYMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N COLUMBIA ST
COVINGTON LA
70433-2108
US

IV. Provider business mailing address

485 BROWNING LOOP
MANDEVILLE LA
70448-1914
US

V. Phone/Fax

Practice location:
  • Phone: 198-587-1393
  • Fax:
Mailing address:
  • Phone: 198-572-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2672
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: