Provider Demographics
NPI:1033697206
Name:STEPHEN K WILLIAMS DDS PC
Entity Type:Organization
Organization Name:STEPHEN K WILLIAMS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-735-2020
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:IN
Mailing Address - Zip Code:47512-0126
Mailing Address - Country:US
Mailing Address - Phone:812-735-2020
Mailing Address - Fax:812-735-2121
Practice Address - Street 1:511 W 11TH ST
Practice Address - Street 2:
Practice Address - City:BICKNELL
Practice Address - State:IN
Practice Address - Zip Code:47512
Practice Address - Country:US
Practice Address - Phone:812-735-2020
Practice Address - Fax:812-735-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007719B1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty