Provider Demographics
NPI:1962401422
Name:WILLIAMS, BART DAVID III (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:BART
Middle Name:DAVID
Last Name:WILLIAMS
Suffix:III
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BRENDAN WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3514
Mailing Address - Country:US
Mailing Address - Phone:864-458-9800
Mailing Address - Fax:864-458-9860
Practice Address - Street 1:39 BRENDAN WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3514
Practice Address - Country:US
Practice Address - Phone:864-458-9800
Practice Address - Fax:864-458-9860
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3585Medicaid
NC2033745Medicare UPIN
SCF60505Medicare UPIN
SCF605050281Medicare ID - Type UnspecifiedMEDICARE