MEDICARE: DR. WILLIAM J PLUMB DDS

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	7315100-9921	UT

General Provider Information

NPI Number	:	1437484698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM J PLUMB DDS

Provider Business Mailing Address
First Line	:	427 W 100 S
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84770-3375
Country	:	US
Telephone Number	:	435-673-9606
Fax Number	:	435-673-6812

Provider Business Practice Location Address
First Line	:	427 W 100 S
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84770-3375
Country	:	US
Telephone Number	:	435-673-9606
Fax Number	:	435-673-6812

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

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	10/06/2009

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