MEDICARE: DR. WILLIAM MUNDY LITAKER JR. D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	NC5405	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NC5405	OTHER	NC	NC DENTAL LICENSE
3	95339	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1083617591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM MUNDY LITAKER JR. D.D.S.

Provider Business Mailing Address
First Line	:	3070 11TH AVENUE DR SE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-8336
Country	:	US
Telephone Number	:	828-695-5778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3070 11TH AVENUE DR SE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-8336
Country	:	US
Telephone Number	:	828-695-5778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	10/19/2018

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Directions to “ DR. WILLIAM MUNDY LITAKER JR. D.D.S.” Practice Location

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