Provider Demographics
NPI:1164553038
Name:WILLIAMS, CASEY JON (DMD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FORGE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17007-9787
Mailing Address - Country:US
Mailing Address - Phone:717-258-3858
Mailing Address - Fax:717-258-8458
Practice Address - Street 1:210 FORGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BOILING SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17007-9787
Practice Address - Country:US
Practice Address - Phone:717-258-3858
Practice Address - Fax:717-258-8458
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029104L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice