Provider Demographics
NPI:1588722615
Name:WILLIAMS, MARSHALL A (DDS)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 27TH ST N
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35207-4554
Mailing Address - Country:US
Mailing Address - Phone:205-324-5130
Mailing Address - Fax:205-324-5188
Practice Address - Street 1:3200 27TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-4554
Practice Address - Country:US
Practice Address - Phone:205-324-5130
Practice Address - Fax:205-324-5188
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631052972OtherTIN NUMBER