1003812397 NPI number — DR. JAMES D WILLIAMS D.D.S.

Table of content: DR. JAMES D WILLIAMS D.D.S. (NPI 1003812397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003812397 NPI number — DR. JAMES D WILLIAMS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
JAMES
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

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:
1003812397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6401 CITATION DR
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
CLARKSTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48346-2992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-625-2011
Provider Business Mailing Address Fax Number:
248-625-9728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6401 CITATION DR
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
CLARKSTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48346-2992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-625-2011
Provider Business Practice Location Address Fax Number:
248-625-9728
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  012419 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12160687 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: JW012419 . This is a "BLUE CROSS MEDICAL PRO #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com