Healthcare Provider Details

I. General information

NPI: 1720046493
Provider Name (Legal Business Name): MICHAEL J WILL M.D., D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 URBANA PIKE SUITE 201
IJAMSVILLE MD
21754-9403
US

IV. Provider business mailing address

PO BOX 7899
SPRINGDALE AR
72766-7899
US

V. Phone/Fax

Practice location:
  • Phone: 301-874-1707
  • Fax: 301-874-1730
Mailing address:
  • Phone: 479-464-5824
  • Fax: 479-725-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12162
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: