Provider Demographics
NPI:1639119290
Name:WESTMORELAND, WILLIAM PALMER (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PALMER
Last Name:WESTMORELAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 FAIRCREST AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-8937
Mailing Address - Country:US
Mailing Address - Phone:706-798-8300
Mailing Address - Fax:888-395-0775
Practice Address - Street 1:2105 FAIRCREST AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-8937
Practice Address - Country:US
Practice Address - Phone:706-798-8300
Practice Address - Fax:888-395-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3941Medicaid