Healthcare Provider Details

I. General information

NPI: 1316934037
Provider Name (Legal Business Name): WILLIAM B COUCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 CAMERADO DR #100
CAMERON PARK CA
95682-7636
US

IV. Provider business mailing address

970 CAMERADO DR #100
CAMERON PARK CA
95682-7636
US

V. Phone/Fax

Practice location:
  • Phone: 530-677-0723
  • Fax: 530-677-0366
Mailing address:
  • Phone: 530-677-0723
  • Fax: 530-677-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number34602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: