Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 14121 | MO |
NPI | 1003099482 |
---|---|
Provider Name | Dr. William Bernard Moorkamp III |
First Address | Rolla, MO 65401-3350 |
Second Address | Rolla, MO 65401-3350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2007 |
Last Update Date | 09/12/2007 |