Active NPI
William George Brandenburg, DDS
- General Practice Dentistry
- Lilburn, GA
National Provider Identifier
1326289992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN008640
- Practice address
- 4068 Five Forks Trickum Rd SW
Lilburn, GA 30047-2341 - Phone
- (770) 923-4630
- NPI assigned
- Mar 11, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN008640 | GA | Primary |
Addresses
Primary practice location
4068 Five Forks Trickum Rd SW
Lilburn, GA 30047-2341
Mailing address
4068 Five Forks Trickum Rd SW
Lilburn, GA 30047-2341
Phone (770) 923-4630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN008640 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236729600000",
"number": "1326289992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4068 FIVE FORKS TRICKUM RD SW",
"city": "LILBURN",
"state": "GA",
"postal_code": "300472341",
"telephone_number": "770-923-4630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4068 FIVE FORKS TRICKUM RD SW",
"city": "LILBURN",
"state": "GA",
"postal_code": "300472341",
"telephone_number": "770-923-4630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANDENBURG",
"first_name": "WILLIAM",
"middle_name": "GEORGE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-03-11",
"last_updated": "2009-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN008640",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lilburn, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.