Provider Demographics
NPI:1871712810
Name:EASTMAN, WILLIAM P (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:EASTMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRANDON RD STE E
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2571
Mailing Address - Country:US
Mailing Address - Phone:662-323-8065
Mailing Address - Fax:662-323-8066
Practice Address - Street 1:100 BRANDON RD STE E
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2571
Practice Address - Country:US
Practice Address - Phone:662-323-8065
Practice Address - Fax:662-323-8066
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1477-721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06231232Medicaid
MS02581532Medicaid