Provider Demographics
NPI:1063430262
Name:WILLIAMS, DAVID S (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 MONTGOMERY PKWY WEST NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-0000
Mailing Address - Country:US
Mailing Address - Phone:505-293-8310
Mailing Address - Fax:505-293-8665
Practice Address - Street 1:10409 MONTGOMERY PKWY NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3852
Practice Address - Country:US
Practice Address - Phone:505-293-8310
Practice Address - Fax:505-293-8665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM12691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics