Provider Demographics
NPI:1558647305
Name:WILLIAMS, NITALYA B (DDS)
Entity type:Individual
Prefix:DR
First Name:NITALYA
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 VIA SAN SEBASTIAN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6659
Mailing Address - Country:US
Mailing Address - Phone:818-261-1345
Mailing Address - Fax:
Practice Address - Street 1:801 N WILMOT RD STE F2
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1700
Practice Address - Country:US
Practice Address - Phone:520-745-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1095821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics