Provider Demographics
NPI:1033746839
Name:WILLIAMS, DANTE LYDELL SR
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:LYDELL
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 N MARGINAL RD APT 304
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-3942
Mailing Address - Country:US
Mailing Address - Phone:216-420-3940
Mailing Address - Fax:
Practice Address - Street 1:5455 N MARGINAL RD APT 304
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-3942
Practice Address - Country:US
Practice Address - Phone:216-420-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000000000000OtherPRIVATE PAY