Provider Demographics
NPI:1487043956
Name:NICHOLAS J. WILLIAMS, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NICHOLAS J. WILLIAMS, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-748-7149
Mailing Address - Street 1:9946 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2036
Mailing Address - Country:US
Mailing Address - Phone:909-748-7149
Mailing Address - Fax:909-748-4560
Practice Address - Street 1:9946 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2036
Practice Address - Country:US
Practice Address - Phone:909-748-7149
Practice Address - Fax:909-748-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty