Provider Demographics
NPI:1194093211
Name:ZACHARY T WILLIAMS DDS MCLD LLC
Entity type:Organization
Organization Name:ZACHARY T WILLIAMS DDS MCLD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MCLD
Authorized Official - Phone:816-419-0946
Mailing Address - Street 1:10760 E STATE ROUTE 350
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-1815
Mailing Address - Country:US
Mailing Address - Phone:816-358-9691
Mailing Address - Fax:
Practice Address - Street 1:10760 E STATE ROUTE 350
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-1815
Practice Address - Country:US
Practice Address - Phone:816-358-9691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZACHARY T WILLIAMS DDS MCLD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110030011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty