MEDICARE: DR. WILLIAM H DAGGETT 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	6852	AZ

General Provider Information

NPI Number	:	1104012723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM H DAGGETT D.D.S.

Provider Business Mailing Address
First Line	:	5745 N PASEO VENTOSO
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-1129
Country	:	US
Telephone Number	:	520-299-9170
Fax Number	:

Provider Business Practice Location Address
First Line	:	4676 E 5TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-7006
Country	:	US
Telephone Number	:	520-323-1462
Fax Number	:

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	10/06/2010

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