Provider Demographics
NPI:1013007327
Name:ROGER C WILLIAMS DDS, INC
Entity Type:Organization
Organization Name:ROGER C WILLIAMS DDS, INC
Other - Org Name:WILLIAMS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-835-7272
Mailing Address - Street 1:2750 DOVER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4501
Mailing Address - Country:US
Mailing Address - Phone:440-835-7272
Mailing Address - Fax:440-835-7269
Practice Address - Street 1:2750 DOVER CENTER RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4501
Practice Address - Country:US
Practice Address - Phone:440-835-7272
Practice Address - Fax:440-835-7269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-15
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty