Provider Demographics
NPI:1316472996
Name:WILLIAMS, CATHY ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:CATHY
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 FEDERAL BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5455
Mailing Address - Country:US
Mailing Address - Phone:619-264-0179
Mailing Address - Fax:
Practice Address - Street 1:5106 FEDERAL BLVD STE 209
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5455
Practice Address - Country:US
Practice Address - Phone:619-264-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1030891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice