Provider Demographics
NPI:1083881387
Name:DR. ERIK D. WILLIAMS DMD, PC
Entity Type:Organization
Organization Name:DR. ERIK D. WILLIAMS DMD, PC
Other - Org Name:MT. AIRY DENTAL PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-242-1204
Mailing Address - Street 1:633 E MOUNT AIRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1147
Mailing Address - Country:US
Mailing Address - Phone:215-242-1204
Mailing Address - Fax:215-248-1249
Practice Address - Street 1:633 E MOUNT AIRY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1147
Practice Address - Country:US
Practice Address - Phone:215-242-1204
Practice Address - Fax:215-248-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-027201-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty