=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710395124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM G HALLIDAY III DDS PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2014
-----------------------------------------------------
Last Update Date | 07/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4910 E GREENWAY RD SUITE 7
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-1653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-992-2996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4910 E GREENWAY RD SUITE 7
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85254-1653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-992-2996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WILLIAM G HALLIDAY III
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 410-258-4539
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 7424
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------