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General NPI Number Information
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NPI Number | 1972514677
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Entity Type | Individual
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Provider Name | WILLIAM DAVID MIMS DMD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 495 W 3RD ST
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City | SYLACAUGA
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State | AL
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Zip | 35150-1916
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Country | US
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Telephone | 256-249-2211
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Fax | 256-249-3719
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Provider Business Mailing Address
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Address Line | 278 MOUNTAIN RIDGE RD
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City | SYLACAUGA
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State | AL
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Zip | 35150-4652
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Country | US
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Telephone | 256-245-6084
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | AL2814
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License Number State | AL
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