Provider Demographics
NPI:1083804520
Name:WILLIAMS, ROLAND MELVIN (DDS)
Entity Type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:MELVIN
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 1:7640 EASTEX FRWY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708
Mailing Address - Country:US
Mailing Address - Phone:409-898-4396
Mailing Address - Fax:409-898-1158
Practice Address - Street 1:7640 EASTEX FRWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708
Practice Address - Country:US
Practice Address - Phone:409-898-4396
Practice Address - Fax:409-898-1158
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist