Provider Demographics
NPI:1821223355
Name:COUCH, WILLIAM MAX JR (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MAX
Last Name:COUCH
Suffix:JR
Gender:M
Credentials:DDS, MDS
Other - Prefix:
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Mailing Address - Street 1:203 PIRKLE FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:770-887-3258
Mailing Address - Fax:770-887-0173
Practice Address - Street 1:203 PIRKLE FERRY RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2525
Practice Address - Country:US
Practice Address - Phone:770-887-3258
Practice Address - Fax:770-887-0173
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA118951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics