Provider Demographics
NPI:1376821777
Name:RATLIFF, WILLIAMSON T (DMD, MD)
Entity Type:Individual
Prefix:
First Name:WILLIAMSON
Middle Name:T
Last Name:RATLIFF
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-5053
Mailing Address - Fax:318-675-4977
Practice Address - Street 1:2121 NW 40TH TER STE C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-5814
Practice Address - Country:US
Practice Address - Phone:352-378-2525
Practice Address - Fax:352-377-9772
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN225641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty