Provider Demographics
NPI:1386233567
Name:DR. MICHAEL WILLIAMS D.D.S.
Entity type:Organization
Organization Name:DR. MICHAEL WILLIAMS D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-763-8323
Mailing Address - Street 1:525 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2101
Mailing Address - Country:US
Mailing Address - Phone:870-763-8323
Mailing Address - Fax:870-762-5267
Practice Address - Street 1:525 N 2ND ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2101
Practice Address - Country:US
Practice Address - Phone:870-763-8323
Practice Address - Fax:870-762-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental