Healthcare Provider Details

I. General information

NPI: 1871712810
Provider Name (Legal Business Name): WILLIAM P. EASTMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BRANDON RD STE E
STARKVILLE MS
39759-2571
US

IV. Provider business mailing address

100 BRANDON RD STE E
STARKVILLE MS
39759-2571
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:
Title or Position:
Credential:
Phone: