Provider Demographics
NPI:1457676827
Name:MICHAEL N WILLIAMS DDS PA
Entity Type:Organization
Organization Name:MICHAEL N WILLIAMS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-684-1470
Mailing Address - Street 1:4902 E 21ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1601
Mailing Address - Country:US
Mailing Address - Phone:316-684-1470
Mailing Address - Fax:316-684-3584
Practice Address - Street 1:4902 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1601
Practice Address - Country:US
Practice Address - Phone:316-684-1470
Practice Address - Fax:316-684-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5597122300000X
KS60536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200548610CMedicaid
KS100221620AMedicaid