MEDICARE: WILLIAM J. ESICAR, D.M.D., P.C.

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	012364	MO

General Provider Information

NPI Number	:	1366585317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM J. ESICAR, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	2903 SAINT MARYS AVE
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-3714
Country	:	US
Telephone Number	:	573-221-0440
Fax Number	:	573-221-0440

Provider Business Practice Location Address
First Line	:	2903 SAINT MARYS AVE
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-3714
Country	:	US
Telephone Number	:	573-221-0440
Fax Number	:	573-221-0440

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM JOSEPH ESICAR
Credential	:	D.M.D.
Telephone Number	:	573-221-0440

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/30/2008

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