1104917848 NPI number — WILLIAMS DDS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104917848 NPI number — WILLIAMS DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMS DDS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104917848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6837 FALLS OF NEUSE RD
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27615-5308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-846-9070
Provider Business Mailing Address Fax Number:
919-846-9552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6837 FALLS OF NEUSE RD
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27615-5308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-846-9070
Provider Business Practice Location Address Fax Number:
919-846-9552
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
M.
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
PART OWNER/MANAGER
Authorized Official Telephone Number:
919-846-9070

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3742 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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