Provider Demographics
NPI:1538328836
Name:MICHAEL O. WILLIAMS DDS.PA
Entity Type:Organization
Organization Name:MICHAEL O. WILLIAMS DDS.PA
Other - Org Name:GULF COAST CENTER FOR ADVANCED COSMETIC ORTHODONICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:228-896-8333
Mailing Address - Street 1:424 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1849
Mailing Address - Country:US
Mailing Address - Phone:228-896-8333
Mailing Address - Fax:228-896-8335
Practice Address - Street 1:424 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1849
Practice Address - Country:US
Practice Address - Phone:228-896-8333
Practice Address - Fax:228-896-8335
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL O. WILLIAMS DDS.PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOR-19-80/1738-761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty