Provider Demographics
NPI:1447236351
Name:WILLIAMS, KEVIN LAMONT (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LAMONT
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 1:111 WESTVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-4132
Mailing Address - Country:US
Mailing Address - Phone:864-582-3266
Mailing Address - Fax:864-582-3159
Practice Address - Street 1:111 WESTVIEW BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-4132
Practice Address - Country:US
Practice Address - Phone:864-582-3266
Practice Address - Fax:864-582-3159
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist