Provider Demographics
NPI:1528244886
Name:DENAMUR, WILLIAM BRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRIAN
Last Name:DENAMUR
Suffix:
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 1:2326 WARM SPRINGS RD
Mailing Address - Street 2:STE A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6860
Mailing Address - Country:US
Mailing Address - Phone:706-324-1415
Mailing Address - Fax:706-324-0844
Practice Address - Street 1:2326 WARM SPRINGS RD
Practice Address - Street 2:STE A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6860
Practice Address - Country:US
Practice Address - Phone:706-324-1415
Practice Address - Fax:706-324-0844
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000263656BMedicaid
811417OtherUNITED CONCORDIA