Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 6531 | NC |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 6531 | NC |
NPI | 1881672863 |
---|---|
Provider Name | Dr. William J Demsar |
First Address | Ft Gordon, GA 30905-5660 |
Second Address | Ft Gordon, GA 30905-5660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 03/07/2013 |