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General NPI Number Information
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NPI Number | 1093972176
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Entity Type | Individual
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Provider Name | WILLIAM B. TACKLER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2008
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Last Update Date | 05/17/2008
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Provider Practice Location Address
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Address Line | 114 E 72ND ST
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City | NEW YORK
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State | NY
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Zip | 10021-4274
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Country | US
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Telephone | 212-734-4885
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Fax | 212-879-0955
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Provider Business Mailing Address
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Address Line | 114 E 72ND ST
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City | NEW YORK
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State | NY
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Zip | 10021-4274
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Country | US
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Telephone | 212-734-4885
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Fax | 212-879-0955
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 042256
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License Number State | NY
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