Provider Demographics
NPI:1750909131
Name:WILLIAMS, DANIEL FARRELL (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:FARRELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 S HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-2797
Mailing Address - Country:US
Mailing Address - Phone:928-358-8642
Mailing Address - Fax:
Practice Address - Street 1:308 N WHITE MOUNTAIN RD STE D
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5200
Practice Address - Country:US
Practice Address - Phone:928-532-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-11
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPD00301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice