Provider Demographics
NPI:1104430677
Name:WILLIAMS, AUSTIN WAYNE (X2)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:WAYNE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:X2
Other - Prefix:
Other - First Name:AUSTIN
Other - Middle Name:WAYNE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:X2
Mailing Address - Street 1:401 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYER
Mailing Address - State:VA
Mailing Address - Zip Code:22211-1009
Mailing Address - Country:US
Mailing Address - Phone:703-696-3460
Mailing Address - Fax:
Practice Address - Street 1:401 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:FORT MYER
Practice Address - State:VA
Practice Address - Zip Code:22211-1009
Practice Address - Country:US
Practice Address - Phone:703-696-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant