MEDICARE: DR. WILLIAM G SHOLD 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		IL

General Provider Information

NPI Number	:	1700955606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM G SHOLD DDS

Provider Business Mailing Address
First Line	:	6050 BRYNWOOD DR
Second Line	:	SUITE 205
City	:	ROCKFORD
State	:	IL
Zip	:	61114-6579
Country	:	US
Telephone Number	:	815-877-7780
Fax Number	:	815-877-7710

Provider Business Practice Location Address
First Line	:	6050 BRYNWOOD DR
Second Line	:	SUITE 205
City	:	ROCKFORD
State	:	IL
Zip	:	61114-6579
Country	:	US
Telephone Number	:	815-877-7780
Fax Number	:	815-877-7710

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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