Provider Demographics
NPI:1093943607
Name:WILLIAMS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WILLIAMS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:AYCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:828-681-8888
Mailing Address - Street 1:3272 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9242
Mailing Address - Country:US
Mailing Address - Phone:828-681-8888
Mailing Address - Fax:828-681-8886
Practice Address - Street 1:3272 HENDERSONVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9242
Practice Address - Country:US
Practice Address - Phone:828-681-8888
Practice Address - Fax:828-681-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty