Provider Demographics
NPI:1518117357
Name:WILLIAMS, EMILY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:M
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 1:444 W FULLERTON PKWY APT 1408
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2848
Mailing Address - Country:US
Mailing Address - Phone:816-682-5696
Mailing Address - Fax:
Practice Address - Street 1:1560 SHERMAN AVE STE 610
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4806
Practice Address - Country:US
Practice Address - Phone:847-869-5417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027003122300000X
IL0210022221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist