Provider Demographics
NPI:1912051202
Name:KAPGAN, WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:KAPGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 TERRELL MILL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:770-984-9000
Mailing Address - Fax:770-984-9256
Practice Address - Street 1:5255 STILESBORO RD NW
Practice Address - Street 2:SUITE 130
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7737
Practice Address - Country:US
Practice Address - Phone:770-499-2152
Practice Address - Fax:770-499-9566
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0132741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA644170460CMedicaid
GA644170460DMedicaid
GA9184400OtherDORAL
GA101162OtherAVESIS