Provider Demographics
NPI:1497932859
Name:WILLIAMS, VANESSA P (DDS)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:P
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 1:2820 N O'CONNOR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:972-594-4888
Mailing Address - Fax:972-594-4839
Practice Address - Street 1:2820 N O'CONNOR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:972-594-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100456320AMedicaid
KS100456320EMedicaid
KS100456340AMedicaid