Provider Demographics
NPI:1366584690
Name:WILLIAMS, MICHAEL JEFFERY (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEFFERY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 WARD BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-6488
Mailing Address - Country:US
Mailing Address - Phone:252-237-1162
Mailing Address - Fax:252-291-9950
Practice Address - Street 1:6000 WARD BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-6488
Practice Address - Country:US
Practice Address - Phone:252-237-1162
Practice Address - Fax:252-291-9950
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999334Medicaid
NCU36054Medicare UPIN