Provider Demographics
NPI:1376604819
Name:WILLIAMS, CORY M (DDS)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:M
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 1:1125 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7304
Mailing Address - Country:US
Mailing Address - Phone:910-763-1072
Mailing Address - Fax:910-763-5699
Practice Address - Street 1:1125 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7304
Practice Address - Country:US
Practice Address - Phone:910-763-1072
Practice Address - Fax:910-763-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice