Provider Demographics
NPI:1225247083
Name:WILLIAMS, ZACHARY THOMAS (DDS, MCLD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:THOMAS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS, MCLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SW LEMANS LN.
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082
Mailing Address - Country:US
Mailing Address - Phone:816-419-0946
Mailing Address - Fax:
Practice Address - Street 1:915 SW LEMANS LN.
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4619
Practice Address - Country:US
Practice Address - Phone:816-537-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59263301223G0001X
MO20110030011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice