=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982942157
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATURE COAST ENDODONTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2013
-----------------------------------------------------
Last Update Date | 01/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7391 COMMERCIAL WAY
-----------------------------------------------------
City | WEEKI WACHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34613-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-592-3636
-----------------------------------------------------
Fax | 352-592-3973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7391 COMMERCIAL WAY
-----------------------------------------------------
City | WEEKI WACHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34613-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-592-3636
-----------------------------------------------------
Fax | 352-592-3973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | NICHOLAS WILLIAMS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 352-592-3636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 16231
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------