Provider Demographics
NPI:1558561845
Name:WILLIAMS, SHAUN BERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:BERRY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23800 ORCHARD LAKE RD
Mailing Address - Street 2:STE. 106
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2560
Mailing Address - Country:US
Mailing Address - Phone:248-755-5700
Mailing Address - Fax:248-471-7383
Practice Address - Street 1:6250 S CEDAR ST
Practice Address - Street 2:STE. 5
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5744
Practice Address - Country:US
Practice Address - Phone:517-394-2226
Practice Address - Fax:517-394-3860
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010196861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice