Healthcare Provider Details

I. General information

NPI: 1104817402
Provider Name (Legal Business Name): WILLIAM ROLAND HOUCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 DUTCHMANS LANE
EASTON MD
21601
US

IV. Provider business mailing address

28864 JASPER LANE
EASTON MD
21601
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-7575
  • Fax: 410-763-8929
Mailing address:
  • Phone: 410-822-7097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4327
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: