MEDICARE: DR. WILLIAM RAY DZYAK D.D.S.,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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8207	MD

General Provider Information

NPI Number	:	1578613592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM RAY DZYAK D.D.S.,P.C.

Provider Business Mailing Address
First Line	:	10605 CONCORD ST
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2504
Country	:	US
Telephone Number	:	301-942-4900
Fax Number	:

Provider Business Practice Location Address
First Line	:	10605 CONCORD ST
Second Line	:	SUITE NUMBER 200
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2504
Country	:	US
Telephone Number	:	301-942-4900
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/09/2007

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