Provider Demographics
NPI:1871941575
Name:MAYHAN, WILLIAM
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:MAYHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 N 168TH CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2201
Mailing Address - Country:US
Mailing Address - Phone:402-614-7111
Mailing Address - Fax:402-614-7597
Practice Address - Street 1:3585 N 168TH CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2201
Practice Address - Country:US
Practice Address - Phone:402-614-7111
Practice Address - Fax:402-614-7597
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist