MEDICARE: DR. WILLIAM MICHAEL NETZLEY D.D.S.

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	122300000X	Dentist	D27546	CA

General Provider Information

NPI Number	:	1790793396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM MICHAEL NETZLEY D.D.S.

Provider Business Mailing Address
First Line	:	608 E HOME AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93728-1726
Country	:	US
Telephone Number	:	559-268-6840
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 N PALM AVE
Second Line	:	SUITE 450
City	:	FRESNO
State	:	CA
Zip	:	93704-2211
Country	:	US
Telephone Number	:	559-227-4078
Fax Number	:	559-227-7402

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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