Provider Demographics
NPI:1285750067
Name:EASTBURN, WILLIAM GERARD (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GERARD
Last Name:EASTBURN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5368 ZEIGLER BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-4334
Mailing Address - Country:US
Mailing Address - Phone:251-344-2126
Mailing Address - Fax:
Practice Address - Street 1:5368 ZEIGLER BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-4334
Practice Address - Country:US
Practice Address - Phone:251-344-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6301204492Medicare UPIN