Healthcare Provider Details

I. General information

NPI: 1104849660
Provider Name (Legal Business Name): WILLIAM EDWARD DINGUS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HIGH ST
NEWARK NY
14513-1456
US

IV. Provider business mailing address

113 JORDACHE LN
SPENCERPORT NY
14559-2062
US

V. Phone/Fax

Practice location:
  • Phone: 585-278-1063
  • Fax:
Mailing address:
  • Phone: 585-889-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number042074
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: