Provider Demographics
NPI:1306875646
Name:STATHAS, WILLIAM NICHOLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NICHOLAS
Last Name:STATHAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2323 N MAYFAIR RD
Mailing Address - Street 2:STE 420
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1534
Mailing Address - Country:US
Mailing Address - Phone:414-456-9020
Mailing Address - Fax:414-456-9021
Practice Address - Street 1:2300 N MAYFAIR RD
Practice Address - Street 2:SUITE 345
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1505
Practice Address - Country:US
Practice Address - Phone:414-456-9020
Practice Address - Fax:414-456-9021
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2076G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice