Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN14622 | FL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 5750 | LA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN14622 | FL |
NPI | 1114191335 |
---|---|
Provider Name | Dr. William Mathurin |
First Address | New Orleans, LA 70125-4703 |
Second Address | Tamarac, FL 33319-7107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2008 |
Last Update Date | 09/07/2020 |