Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5471 | NC |
NPI | 1023075520 |
---|---|
Provider Name | William Bechtold |
First Address | Durham, NC 27704-2621 |
Second Address | Durham, NC 27704-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89-90567 | (05) | NC |
90567 | BCBS PROVIDER ID (01) | NC |
T63945 | (02) |