Provider Demographics
NPI:1598148587
Name:J MICHAEL WILLIAMS DMD LLC
Entity Type:Organization
Organization Name:J MICHAEL WILLIAMS DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-945-5533
Mailing Address - Street 1:2676 CHARLESTOWN RD
Mailing Address - Street 2:STE 1
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2574
Mailing Address - Country:US
Mailing Address - Phone:812-945-5533
Mailing Address - Fax:812-945-0557
Practice Address - Street 1:2676 CHARLESTOWN RD
Practice Address - Street 2:STE 1
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2574
Practice Address - Country:US
Practice Address - Phone:812-945-5533
Practice Address - Fax:812-945-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010335A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty