Provider Demographics
NPI:1366585317
Name:WILLIAM J. ESICAR, D.M.D., P.C.
Entity type:Organization
Organization Name:WILLIAM J. ESICAR, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ESICAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:573-221-0440
Mailing Address - Street 1:2903 SAINT MARYS AVE
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3714
Mailing Address - Country:US
Mailing Address - Phone:573-221-0440
Mailing Address - Fax:573-221-0440
Practice Address - Street 1:2903 SAINT MARYS AVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-3714
Practice Address - Country:US
Practice Address - Phone:573-221-0440
Practice Address - Fax:573-221-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0123641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty