Provider Demographics
NPI:1093490070
Name:WILLIAMS, MACKENZIE (DDS)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17991 CLEAR WATER DR
Mailing Address - Street 2:
Mailing Address - City:HENSLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72065-8111
Mailing Address - Country:US
Mailing Address - Phone:501-352-6540
Mailing Address - Fax:
Practice Address - Street 1:3420 HICKORY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8804
Practice Address - Country:US
Practice Address - Phone:574-256-1579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014151A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice