Provider Demographics
NPI:1215130810
Name:WILLIAMS, FAYETTE CREED (DDS, MD)
Entity type:Individual
Prefix:
First Name:FAYETTE
Middle Name:CREED
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1625 SAINT LOUIS AVENUE
Mailing Address - Street 2:HOUSE STAFF & GME
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-927-1325
Mailing Address - Fax:817-927-1035
Practice Address - Street 1:1625 SAINT LOUIS AVENUE
Practice Address - Street 2:HOUSE STAFF & GME
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-927-1325
Practice Address - Fax:817-927-1035
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX211611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery