Provider Demographics
NPI:1295309854
Name:WILLIAMS DENTAL LLC
Entity type:Organization
Organization Name:WILLIAMS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-446-0032
Mailing Address - Street 1:2310 FORUM BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5461
Mailing Address - Country:US
Mailing Address - Phone:573-446-0032
Mailing Address - Fax:573-447-4424
Practice Address - Street 1:2310 FORUM BLVD SUITE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5461
Practice Address - Country:US
Practice Address - Phone:573-446-0032
Practice Address - Fax:573-447-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental