Provider Demographics
NPI:1265530059
Name:FETCHKO, WILLIAM JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:FETCHKO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:11249 US ROUTE 422
Mailing Address - City:ELDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:15736-0458
Mailing Address - Country:US
Mailing Address - Phone:724-354-3512
Mailing Address - Fax:724-354-3014
Practice Address - Street 1:11249 US ROUTE 422
Practice Address - Street 2:
Practice Address - City:ELDERTON
Practice Address - State:PA
Practice Address - Zip Code:15736-0458
Practice Address - Country:US
Practice Address - Phone:724-354-3512
Practice Address - Fax:724-354-3014
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027175L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA672336OtherUNITED CONCORDIA