Provider Demographics
NPI:1437243631
Name:WILLIAMS DENTAL ASSOCIATES NORTH
Entity Type:Organization
Organization Name:WILLIAMS DENTAL ASSOCIATES NORTH
Other - Org Name:KNOX PARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-265-7771
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:FERRIS
Mailing Address - State:TX
Mailing Address - Zip Code:75125-0462
Mailing Address - Country:US
Mailing Address - Phone:972-842-5707
Mailing Address - Fax:972-842-5324
Practice Address - Street 1:3001 KNOX ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5584
Practice Address - Country:US
Practice Address - Phone:214-265-7771
Practice Address - Fax:214-219-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296003OtherUNITED HEALTHCARE
TX865491OtherUNITED CONCORDIA
TX96DLOtherBLUE CROSS BLUE SHIELD