Provider Demographics
NPI:1215022322
Name:ROBERT L WILLIAMSON III DDS PA
Entity Type:Organization
Organization Name:ROBERT L WILLIAMSON III DDS PA
Other - Org Name:PRINCETON COMPREHENSIVE & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-624-7207
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569
Mailing Address - Country:US
Mailing Address - Phone:919-936-2418
Mailing Address - Fax:919-936-2789
Practice Address - Street 1:104 CENTER STREET
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NC
Practice Address - Zip Code:27569
Practice Address - Country:US
Practice Address - Phone:919-936-2418
Practice Address - Fax:919-936-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7986122300000X
NC70381223G0001X
NC27491223G0001X
NC80351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902047Medicaid
NC5901114Medicaid
NC89902EJMedicaid
NC5902047Medicaid
NC5901114Medicaid
NC1427100593Medicare UPIN