Provider Demographics
NPI:1457494809
Name:WILLIAMS, MATTHEW ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
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 1:11130 QUAIL RISE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3334
Mailing Address - Country:US
Mailing Address - Phone:210-690-1843
Mailing Address - Fax:
Practice Address - Street 1:7430 LOUIS PASTEUR DR
Practice Address - Street 2:TX DEPT. OF STATE HEALTH SERVICES, ORAL HEALTH PROGRAM
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4507
Practice Address - Country:US
Practice Address - Phone:210-949-2124
Practice Address - Fax:210-949-2041
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18403122300000X, 1223D0001X
KY5983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223D0001XDental ProvidersDentistDental Public Health