Provider Demographics
NPI:1114077591
Name:WILLIAMS, MICHAEL KURT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KURT
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 1:12616 EAGLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6974
Mailing Address - Country:US
Mailing Address - Phone:804-269-4130
Mailing Address - Fax:540-967-5858
Practice Address - Street 1:411 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093-6518
Practice Address - Country:US
Practice Address - Phone:540-967-5800
Practice Address - Fax:540-967-5858
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice