Provider Demographics
NPI:1972693869
Name:CLEVELAND, WILLIAM NALL (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NALL
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 W HAMLET AVENUE
Mailing Address - Street 2:PO BOX 471
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345
Mailing Address - Country:US
Mailing Address - Phone:910-582-3095
Mailing Address - Fax:910-582-8841
Practice Address - Street 1:317 W HAMLET AVENUE
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345
Practice Address - Country:US
Practice Address - Phone:910-582-3095
Practice Address - Fax:910-582-8841
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8491661Medicaid