Active NPI
William L Priddy, D.D.S.
- Dentist
- Saint Louis, MO
National Provider Identifier
1962467571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5110
- Practice address
- 12647 Olive Blvd
Suite 600
Saint Louis, MO 63141-6345 - Phone
- (314) 744-4100
- NPI assigned
- Apr 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5110 | MD | Primary |
Addresses
Primary practice location
12647 Olive Blvd
Suite 600
Saint Louis, MO 63141-6345
Mailing address
309 Pinpail Lane
Annapolis, MD 21409
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5110 | MD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1962467571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 PINPAIL LANE",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "21409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12647 OLIVE BLVD",
"address_2": "SUITE 600",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416345",
"telephone_number": "314-744-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRIDDY",
"first_name": "WILLIAM",
"middle_name": "L",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-18",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "5110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.