Provider Demographics
NPI:1063597474
Name:TAPP, WILLIAM JOUETTE III (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOUETTE
Last Name:TAPP
Suffix:III
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 1:1018 HWY 70 WEST
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2562
Mailing Address - Country:US
Mailing Address - Phone:919-779-2609
Mailing Address - Fax:919-779-4451
Practice Address - Street 1:1018 HWY 70 WEST
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2562
Practice Address - Country:US
Practice Address - Phone:919-779-2609
Practice Address - Fax:919-779-4451
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42591223G0001X
WV23241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC98256OtherBLUE CROSS & BLUE SHILD
WV2324OtherDENTAL LIC. NUMBER
NC4259OtherDENTAL LIC. NUMBER
AT7259321OtherDEA REG. NUMBER