Healthcare Provider Details

I. General information

NPI: 1528143229
Provider Name (Legal Business Name): WILLIAM J CLINE DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20A FELTON PLACE
CARTERSVILLE GA
30120
US

IV. Provider business mailing address

PO BOX 201421
CARTERSVILLE GA
30120
US

V. Phone/Fax

Practice location:
  • Phone: 770-382-8380
  • Fax: 770-382-5575
Mailing address:
  • Phone: 770-382-8380
  • Fax: 770-382-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN012007
License Number StateGA

VIII. Authorized Official

Name: WILLIAM JAMES CLINE
Title or Position: CEO
Credential: DMD
Phone: 770-382-8380