1912051202 NPI number — DR. WILLIAM KAPGAN DDS

Table of content: DR. WILLIAM KAPGAN DDS (NPI 1912051202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912051202 NPI number — DR. WILLIAM KAPGAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAPGAN
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912051202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1410 TERRELL MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-984-9000
Provider Business Mailing Address Fax Number:
770-984-9256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5255 STILESBORO RD NW
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30152-7737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-499-2152
Provider Business Practice Location Address Fax Number:
770-499-9566
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  DN013274 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 644170460C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 644170460D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9184400 . This is a "DORAL" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 101162 . This is a "AVESIS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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