MEDICARE: WILLIAM LAY DDS PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1760053870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM LAY DDS PLLC

Provider Business Mailing Address
First Line	:	1810 S BOWEN RD
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-3340
Country	:	US
Telephone Number	:	817-274-1825
Fax Number	:	682-247-0475

Provider Business Practice Location Address
First Line	:	1810 S BOWEN RD
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-3340
Country	:	US
Telephone Number	:	817-274-1825
Fax Number	:	692-247-0475

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM LAY
Credential	:	DDS
Telephone Number	:	817-274-1825

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	07/09/2021

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