Provider Demographics
NPI:1063584282
Name:ROBERT L WILLIAMSON, III, DDS3, PA
Entity type:Organization
Organization Name:ROBERT L WILLIAMSON, III, DDS3, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-624-7207
Mailing Address - Street 1:1624 PRINCESS ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3848
Mailing Address - Country:US
Mailing Address - Phone:910-251-8174
Mailing Address - Fax:910-341-3037
Practice Address - Street 1:1624 PRINCESS ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3848
Practice Address - Country:US
Practice Address - Phone:910-251-8174
Practice Address - Fax:910-341-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7986122300000X
NC8411122300000X
NC8852122300000X
NC260100122300000X
NC70381223G0001X
NC8999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2058663Medicaid
NC5901114Medicaid
NC89902EJMedicaid
NC5907981Medicaid
NC1568661155Medicare UPIN
NC1427100593Medicare UPIN
NC2058663Medicaid
NC89902EJMedicaid
NC5907981Medicaid