Provider Demographics
NPI:1982739736
Name:WILLIAM, SALLY (DDS)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:WILLIAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:HABIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:659 S CENTRAL VALLEY HWY
Mailing Address - Street 2:P.O. BOX 1060
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2790
Mailing Address - Country:US
Mailing Address - Phone:661-459-1900
Mailing Address - Fax:661-459-1974
Practice Address - Street 1:525 ROBERTS LANE
Practice Address - Street 2:
Practice Address - City:OILDALE
Practice Address - State:CA
Practice Address - Zip Code:93308-0000
Practice Address - Country:US
Practice Address - Phone:661-392-7850
Practice Address - Fax:661-215-2349
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist