Provider Demographics
NPI:1689637910
Name:ACKERMAN, WILLIAM GRAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GRAY
Last Name:ACKERMAN
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 1:342 CALHOUN AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-2011
Mailing Address - Country:US
Mailing Address - Phone:864-229-7979
Mailing Address - Fax:
Practice Address - Street 1:342 CALHOUN AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-2011
Practice Address - Country:US
Practice Address - Phone:864-229-7979
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC200401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ20040Medicaid