MEDICARE: WILLIAM ASHLEY SAPP 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	122300000X	Dentist	002259	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD2259	OTHER	NM	STATE LICENSE

General Provider Information

NPI Number	:	1952381774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM ASHLEY SAPP DDS

Provider Business Mailing Address
First Line	:	10000 COORS BYP NW
Second Line	:	G 218
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4040
Country	:	US
Telephone Number	:	505-242-4867
Fax Number	:	505-890-2883

Provider Business Practice Location Address
First Line	:	10000 COORS BYP NW
Second Line	:	G-218
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4040
Country	:	US
Telephone Number	:	505-242-4867
Fax Number	:	505-890-2883

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	03/23/2012

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