Provider Demographics
NPI:1568021657
Name:WILLIAMS, MAKENNA HELENE (DMD)
Entity Type:Individual
Prefix:MS
First Name:MAKENNA
Middle Name:HELENE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MELLWOOD AVE APT 1318
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1075
Mailing Address - Country:US
Mailing Address - Phone:410-703-7408
Mailing Address - Fax:
Practice Address - Street 1:3946 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1450
Practice Address - Country:US
Practice Address - Phone:502-276-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist