Provider Demographics
NPI:1417694845
Name:STEVE AND HARLEY WILLIAMS DDS PC
Entity Type:Organization
Organization Name:STEVE AND HARLEY WILLIAMS DDS PC
Other - Org Name:ROOTS AND GUMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:VICENTA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:999 E STANLEY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4050
Mailing Address - Country:US
Mailing Address - Phone:925-371-0300
Mailing Address - Fax:
Practice Address - Street 1:999 E STANLEY BLVD STE C
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4050
Practice Address - Country:US
Practice Address - Phone:925-371-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty