Provider Demographics
NPI:1255419107
Name:ARENDT, WILLIAM CHARLES JR (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:ARENDT
Suffix:JR
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 1:110 BASTILLE WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7620
Mailing Address - Country:US
Mailing Address - Phone:770-460-0532
Mailing Address - Fax:770-461-6766
Practice Address - Street 1:110 BASTILLE WAY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7620
Practice Address - Country:US
Practice Address - Phone:770-460-0532
Practice Address - Fax:770-461-6766
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist