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NPI Code Detail

MEDICARE: DR. WILLIAM BRYAN BOAK D.M.D.

MEDICARE: DR. WILLIAM BRYAN BOAK D.M.D.
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
11223G0001XGeneral Practice DentistryDS025414LPA

General Provider Information

NPI Number : 1205953502
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM BRYAN BOAK D.M.D.
Provider Business Mailing Address
First Line : 1910 E CARSON ST
Second Line :
City : PITTSBURGH
State : PA
Zip : 15203-1880
Country : US
Telephone Number : 412-381-3373
Fax Number : 412-381-2829
Provider Business Practice Location Address
First Line : 1910 E CARSON ST
Second Line :
City : PITTSBURGH
State : PA
Zip : 15203-1880
Country : US
Telephone Number : 412-381-3373
Fax Number : 412-381-2829
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/22/2013

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