Provider Demographics
NPI:1497857775
Name:WILLIAMS, EDWARD LEE (DMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEE
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 1:36 ASPEN WAY
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3084
Mailing Address - Country:US
Mailing Address - Phone:831-728-2266
Mailing Address - Fax:831-728-3006
Practice Address - Street 1:36 ASPEN WAY
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3084
Practice Address - Country:US
Practice Address - Phone:831-728-2266
Practice Address - Fax:831-728-3006
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB32668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist