Provider Demographics
NPI:1295011369
Name:WILLIAMS, MARVIN EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:EUGENE
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 1:3913 E. LANCASTER
Mailing Address - Street 2:
Mailing Address - City:FT. WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103
Mailing Address - Country:US
Mailing Address - Phone:817-536-1976
Mailing Address - Fax:
Practice Address - Street 1:3913 E. LANCASTER
Practice Address - Street 2:
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103
Practice Address - Country:US
Practice Address - Phone:817-536-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice