Provider Demographics
NPI:1477703817
Name:ANNETTE WILLIAMSON DDS, P.C.
Entity Type:Organization
Organization Name:ANNETTE WILLIAMSON DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-663-4200
Mailing Address - Street 1:11043 BROADWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8834
Mailing Address - Country:US
Mailing Address - Phone:219-663-4200
Mailing Address - Fax:219-663-4700
Practice Address - Street 1:11043 BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8834
Practice Address - Country:US
Practice Address - Phone:219-663-4200
Practice Address - Fax:219-663-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008946A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty