Provider Demographics
NPI:1427495621
Name:JENNY MCWILLIAMS DDS PC
Entity type:Organization
Organization Name:JENNY MCWILLIAMS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-477-2836
Mailing Address - Street 1:701 N WEINBACH AVE
Mailing Address - Street 2:SUITE 910
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-5990
Mailing Address - Country:US
Mailing Address - Phone:812-477-2836
Mailing Address - Fax:
Practice Address - Street 1:701 N WEINBACH AVE
Practice Address - Street 2:SUITE 910
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-5990
Practice Address - Country:US
Practice Address - Phone:812-477-2836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010009A122300000X
IN12006664A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty