Provider Demographics
NPI:1477501120
Name:WILLIAMS, EDWARD J (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
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 1:6958 SHIMMERING DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3331
Mailing Address - Country:US
Mailing Address - Phone:863-646-2989
Mailing Address - Fax:863-646-2890
Practice Address - Street 1:6958 SHIMMERING DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3331
Practice Address - Country:US
Practice Address - Phone:863-646-2989
Practice Address - Fax:863-646-2890
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 106711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice