Provider Demographics
NPI:1053448563
Name:WILLIAMSON, CHADWICK NEAL (DDS)
Entity Type:Individual
Prefix:
First Name:CHADWICK
Middle Name:NEAL
Last Name:WILLIAMSON
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 1:5801 W 44TH AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7402
Mailing Address - Country:US
Mailing Address - Phone:303-433-1239
Mailing Address - Fax:
Practice Address - Street 1:5801 W 44TH AVE
Practice Address - Street 2:UNIT C
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7488
Practice Address - Country:US
Practice Address - Phone:303-433-1239
Practice Address - Fax:303-455-5317
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84451223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77902033Medicaid
CO8445OtherDENTAL LICENSE NUMBER