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General NPI Number Information
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NPI Number | 1639353519
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Entity Type | Organization
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Legal Business Name | W. P. EASTMAN, D.D.S., P.A.
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 100 BRANDON RD. STE. E
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City | STARKVILLE
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State | MS
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Zip | 39759
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Country | US
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Telephone | 662-323-8065
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Fax | 662-323-8066
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Provider Business Mailing Address
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Address Line | 100 BRANDON RD. STE. E
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City | STARKVILLE
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State | MS
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Zip | 39759
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Country | US
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Telephone | 662-323-8065
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Fax | 662-323-8066
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM P EASTMAN
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Credential | D.D.S.
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Telephone | 662-323-8065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1477-72
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License Number State | MS
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