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General NPI Number Information
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NPI Number | 1619070042
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Entity Type | Individual
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Provider Name | WILLIAM E D JANTZEN JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 160 OLD DERBY ST
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City | HINGHAM
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State | MA
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Zip | 02043
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Country | US
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Telephone | 781-749-8606
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Fax | 781-749-8607
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Provider Business Mailing Address
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Address Line | 32 WINTROP RD
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City | HINGHAM
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State | MA
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Zip | 02043
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Country | US
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Telephone | 781-749-8808
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Fax |
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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 | 14223
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License Number State | MA
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