Provider Demographics
NPI:1073632584
Name:WILLIAMS, RUSSELL ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ANDREW
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 1:9821 KATY FWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1207
Mailing Address - Country:US
Mailing Address - Phone:713-465-1234
Mailing Address - Fax:713-461-7777
Practice Address - Street 1:9821 KATY FWY
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1207
Practice Address - Country:US
Practice Address - Phone:713-465-1234
Practice Address - Fax:713-461-7777
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice