Individual
DR. WILLIAM G BUMGARNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6770 SELMAN DR, DOUGLASVILLE, GA 30134-1756
(770) 949-7359
Mailing address
6770 SELMAN DR, DOUGLASVILLE, GA 30134-1756
(770) 949-7359
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
DN008602
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000153414E
—
GA
05
—
000153414F
—
GA
01
—
102300
AVESIS
GA
01
—
9208296
DORAL
GA
Enumeration date
12/05/2007
Last updated
09/23/2008
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