MEDICARE: DR. WILLIAM F. MORANG D.M.D.

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	DN014466	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN014466	OTHER	GA	DENTAL LICENSE

General Provider Information

NPI Number	:	1659620193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM F. MORANG D.M.D.

Provider Business Mailing Address
First Line	:	1520-A JENNINGS MILL RD.
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-2543
Country	:	US
Telephone Number	:	706-353-1958
Fax Number	:	706-353-3939

Provider Business Practice Location Address
First Line	:	1520-A JENNINGS MILL RD.
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-2543
Country	:	US
Telephone Number	:	706-353-1958
Fax Number	:	706-353-3939

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

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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