Healthcare Provider Details

I. General information

NPI: 1912051202
Provider Name (Legal Business Name): WILLIAM KAPGAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 STILESBORO RD NW SUITE 130
KENNESAW GA
30152-7737
US

IV. Provider business mailing address

1410 TERRELL MILL RD
MARIETTA GA
30067
US

V. Phone/Fax

Practice location:
  • Phone: 770-499-2152
  • Fax: 770-499-9566
Mailing address:
  • Phone: 770-984-9000
  • Fax: 770-984-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN013274
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: