MEDICARE: DR. WILLIAM B COUCH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	34602	CA

General Provider Information

NPI Number	:	1316934037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM B COUCH DMD

Provider Business Mailing Address
First Line	:	970 CAMERADO DR
Second Line	:	#100
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-7636
Country	:	US
Telephone Number	:	530-677-0723
Fax Number	:	530-677-0366

Provider Business Practice Location Address
First Line	:	970 CAMERADO DR
Second Line	:	#100
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-7636
Country	:	US
Telephone Number	:	530-677-0723
Fax Number	:	530-677-0366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/08/2007

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