Provider Demographics
NPI:1386662625
Name:WILLIAMS, JEFFREY J (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DONOHOE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6986
Mailing Address - Country:US
Mailing Address - Phone:724-836-1777
Mailing Address - Fax:724-538-8404
Practice Address - Street 1:121 DONOHOE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6986
Practice Address - Country:US
Practice Address - Phone:724-836-1777
Practice Address - Fax:724-538-8404
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025311L1223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS025311LOtherDENTAL LICENSE