Provider Demographics
NPI:1225132590
Name:WILLIAMS, HARRIS E (DDS)
Entity Type:Individual
Prefix:
First Name:HARRIS
Middle Name:E
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 1:6621 KIRBY CENTER CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4313
Mailing Address - Country:US
Mailing Address - Phone:901-362-6103
Mailing Address - Fax:901-362-6694
Practice Address - Street 1:6621 KIRBY CENTER CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4313
Practice Address - Country:US
Practice Address - Phone:901-362-6103
Practice Address - Fax:901-362-6694
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000025701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL89018612OtherBLUE CROSS BLUE SHIELD
TN3724884Medicaid
TN2003076OtherBLUE CROSS BLUE SHIELD
MS02054027Medicaid
151535OtherUNITED CONCORDIA
T74266Medicare UPIN
TN3724884Medicare ID - Type UnspecifiedGROUP #
TN2003076OtherBLUE CROSS BLUE SHIELD