Provider Demographics
NPI:1194857334
Name:WILLIAMS, JEFFREY SAGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SAGE
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:PO BOX 158
Mailing Address - Street 2:1009 CROWDER DRIVE
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-0158
Mailing Address - Country:US
Mailing Address - Phone:804-794-8745
Mailing Address - Fax:
Practice Address - Street 1:1009 CROWDER DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4237
Practice Address - Country:US
Practice Address - Phone:804-794-8745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA45191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice