Provider Demographics
NPI:1992871388
Name:PRIESTER, WILLIAM RAYFORD III (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RAYFORD
Last Name:PRIESTER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:5866 RIDGE BEND RD
Mailing Address - Street 2:SUITE
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9477
Mailing Address - Country:US
Mailing Address - Phone:901-767-8759
Mailing Address - Fax:901-767-0763
Practice Address - Street 1:5866 RIDGE BEND RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9477
Practice Address - Country:US
Practice Address - Phone:901-767-8759
Practice Address - Fax:901-767-0763
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN24981223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN016333TNDOtherECID
TN2498OtherDENTAL LICENSE NUMBER
TNH20021404OtherHIPPA
TNAP5978474OtherPRESCREPTION LICENSE NUMB
TN0170462OtherBLUE CROSS AND BLUE SHIEL