Healthcare Provider Details

I. General information

NPI: 1740415520
Provider Name (Legal Business Name): WILLIAM K DAHL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 FRENCH ST
BANGOR ME
04401-5064
US

IV. Provider business mailing address

205 FRENCH ST
BANGOR ME
04401-5064
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-5554
  • Fax: 204-945-5196
Mailing address:
  • Phone: 207-945-5554
  • Fax: 204-945-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD200
License Number StateME

VIII. Authorized Official

Name: WILLIAM K DAHL
Title or Position: OWNER
Credential: DPM
Phone: 207-945-5554