Provider Demographics
NPI:1003812397
Name:WILLIAMS, JAMES D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
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 1:6401 CITATION DR
Mailing Address - Street 2:STE B
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2992
Mailing Address - Country:US
Mailing Address - Phone:248-625-2011
Mailing Address - Fax:248-625-9728
Practice Address - Street 1:6401 CITATION DR
Practice Address - Street 2:STE B
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2992
Practice Address - Country:US
Practice Address - Phone:248-625-2011
Practice Address - Fax:248-625-9728
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0124191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12160687Medicaid
MIJW012419OtherBLUE CROSS MEDICAL PRO #
MI12160687Medicaid
MIJW012419OtherBLUE CROSS MEDICAL PRO #