Provider Demographics
NPI:1316934037
Name:COUCH, WILLIAM B (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:COUCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:970 CAMERADO DR
Mailing Address - Street 2:#100
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7636
Mailing Address - Country:US
Mailing Address - Phone:530-677-0723
Mailing Address - Fax:530-677-0366
Practice Address - Street 1:970 CAMERADO DR
Practice Address - Street 2:#100
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-7636
Practice Address - Country:US
Practice Address - Phone:530-677-0723
Practice Address - Fax:530-677-0366
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA346021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice