Individual
DR. WILLIAM RANDOL WOMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7505 W DEER VALLEY RD, SUITE 120, PEORIA, AZ 85382-2107
(623) 572-8855
Mailing address
7505 W DEER VALLEY RD, SUITE 120, PEORIA, AZ 85382-2107
(623) 572-8855
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
1827
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2029687771
TAX ID
AZ
Enumeration date
03/28/2006
Last updated
08/16/2007
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