Provider Demographics
NPI:1497040950
Name:WILLIAMS, MARY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LYNN
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 1:1436 W GRAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4927
Mailing Address - Country:US
Mailing Address - Phone:713-521-3131
Mailing Address - Fax:713-521-1222
Practice Address - Street 1:1436 W GRAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4927
Practice Address - Country:US
Practice Address - Phone:713-521-3131
Practice Address - Fax:713-521-1222
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice