Healthcare Provider Details

I. General information

NPI: 1639353519
Provider Name (Legal Business Name): W. P. EASTMAN, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BRANDON RD. STE. E
STARKVILLE MS
39759
US

IV. Provider business mailing address

100 BRANDON RD. STE. E
STARKVILLE MS
39759
US

V. Phone/Fax

Practice location:
  • Phone: 662-323-8065
  • Fax: 662-323-8066
Mailing address:
  • Phone: 662-323-8065
  • Fax: 662-323-8066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1477-72
License Number StateMS

VIII. Authorized Official

Name: WILLIAM P EASTMAN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 662-323-8065