Provider Demographics
NPI:1992014500
Name:WILLIAMS, COLISTA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:COLISTA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:COLISTA
Other - Middle Name:MARIE
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8761 SOUTHWESTERN BLVD
Mailing Address - Street 2:APT 1131
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-2721
Mailing Address - Country:US
Mailing Address - Phone:248-761-0698
Mailing Address - Fax:
Practice Address - Street 1:2517 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-8501
Practice Address - Country:US
Practice Address - Phone:214-275-0172
Practice Address - Fax:214-275-8523
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00260071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice