MEDICARE: WILLIAM DAVID SHORT DMD

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	122300000X	Dentist	4403	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

General Provider Information

NPI Number	:	1194114751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM DAVID SHORT DMD

Provider Business Mailing Address
First Line	:	1619 LIVE OAK ST
Second Line	:
City	:	BEAUFORT
State	:	NC
Zip	:	28516-1520
Country	:	US
Telephone Number	:	252-728-4570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 LIVE OAK ST
Second Line	:
City	:	BEAUFORT
State	:	NC
Zip	:	28516-1520
Country	:	US
Telephone Number	:	252-728-4570
Fax Number	:

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

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	01/20/2015

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