Provider Demographics
NPI:1467443390
Name:WILLIAMS, DEBORAH MAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:MAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4225
Mailing Address - Country:US
Mailing Address - Phone:870-735-2540
Mailing Address - Fax:
Practice Address - Street 1:300 W TYLER AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4225
Practice Address - Country:US
Practice Address - Phone:870-735-2540
Practice Address - Fax:870-735-2917
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128654608Medicaid