Provider Demographics
NPI:1174743199
Name:MONCEVICZ, WILLIAM DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:MONCEVICZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3521 SILVERSIDE RD
Mailing Address - Street 2:QUILLEN BUILDING SUITE 2H
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4900
Mailing Address - Country:US
Mailing Address - Phone:302-477-9779
Mailing Address - Fax:302-477-9119
Practice Address - Street 1:3521 SILVERSIDE RD
Practice Address - Street 2:QUILLEN BUILDING SUITE 2H
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4900
Practice Address - Country:US
Practice Address - Phone:302-477-9779
Practice Address - Fax:302-477-9119
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20042119891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice