Healthcare Provider Details

I. General information

NPI: 1386175149
Provider Name (Legal Business Name): WILLIAM CHRISTIAN BERTRAM DESONNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WRANGLEBORO RD STE 740
MAYS LANDING NJ
08330-4419
US

IV. Provider business mailing address

1401 NEW RD
LINWOOD NJ
08221-1121
US

V. Phone/Fax

Practice location:
  • Phone: 609-829-3101
  • Fax:
Mailing address:
  • Phone: 609-829-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02779600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: