Provider Demographics
NPI:1235346982
Name:WILLIAMSON, RONNIE THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:THOMAS
Last Name:WILLIAMSON
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 1:26789 WOODWARD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1334
Mailing Address - Country:US
Mailing Address - Phone:248-399-4455
Mailing Address - Fax:248-399-5622
Practice Address - Street 1:26789 WOODWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1334
Practice Address - Country:US
Practice Address - Phone:248-399-4455
Practice Address - Fax:248-399-5622
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI013659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist