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General NPI Number Information
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NPI Number | 1972800175
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Entity Type | Organization
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Legal Business Name | W. MAX COUCH, JR., DDS, MDS, LLC
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 2714 EAST FIRST STREET
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City | BLUE RIDGE
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State | GA
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Zip | 30513
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Country | US
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Telephone | 770-833-9150
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Fax | 706-946-2672
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Provider Business Mailing Address
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Address Line | 2714 EAST FIRST STREET
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City | BLUE RIDGE
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State | GA
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Zip | 30513
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Country | US
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Telephone | 770-833-9150
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Fax | 706-946-2672
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Authorized Official
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Title or Position | PRESIDENT/ ORTHODONTIST
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Name | DR. WILLIAM MAX COUCH JR.
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Credential | DDS, MDS
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Telephone | 770-833-9150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 011895
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License Number State | GA
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