Provider Demographics
NPI:1063527604
Name:MASTORAKOS, WILLIAM L (DDS MS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:MASTORAKOS
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Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:10115 MANCHESTER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122
Mailing Address - Country:US
Mailing Address - Phone:314-966-4117
Mailing Address - Fax:314-966-8630
Practice Address - Street 1:10115 MANCHESTER RD
Practice Address - Street 2:STE 200
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122
Practice Address - Country:US
Practice Address - Phone:314-966-4117
Practice Address - Fax:314-966-8630
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO0136001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics