Provider Demographics
NPI:1285780908
Name:NICOLE WILLIAMS D.D.S., P.A.
Entity type:Organization
Organization Name:NICOLE WILLIAMS D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:KELLEY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-881-0909
Mailing Address - Street 1:1310 WAYNE MEMORIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2269
Mailing Address - Country:US
Mailing Address - Phone:919-881-0909
Mailing Address - Fax:919-881-0730
Practice Address - Street 1:1310 WAYNE MEMORIAL DR STE C
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2269
Practice Address - Country:US
Practice Address - Phone:919-881-0909
Practice Address - Fax:919-881-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905716Medicaid