Provider Demographics
NPI:1124375829
Name:KERRY B. WILLIAMS D.D.S.
Entity Type:Organization
Organization Name:KERRY B. WILLIAMS D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:432-758-9839
Mailing Address - Street 1:1006 HOBBS HWY
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3322
Mailing Address - Country:US
Mailing Address - Phone:432-758-9839
Mailing Address - Fax:432-758-2668
Practice Address - Street 1:1006 HOBBS HWY
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3322
Practice Address - Country:US
Practice Address - Phone:432-758-9839
Practice Address - Fax:432-758-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1255344990OtherINDIVIDUAL NPI