Healthcare Provider Details

I. General information

NPI: 1134221203
Provider Name (Legal Business Name): WILLIAM BERNARD MULDOON JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 COUNTY ROAD
MATTAPOISETT MA
02739-0464
US

IV. Provider business mailing address

PO BOX 464 74 COUNTY ROAD
MATTAPOISETT MA
02739-0464
US

V. Phone/Fax

Practice location:
  • Phone: 508-758-4925
  • Fax: 508-758-4313
Mailing address:
  • Phone: 508-758-4925
  • Fax: 508-758-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number13066
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: