Provider Demographics
NPI:1598887572
Name:LEONARD H MCWILLIAMS DDS LLC
Entity Type:Organization
Organization Name:LEONARD H MCWILLIAMS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-462-1315
Mailing Address - Street 1:501 BON AMI ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4925
Mailing Address - Country:US
Mailing Address - Phone:337-462-1315
Mailing Address - Fax:337-462-6411
Practice Address - Street 1:501 BON AMI ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4925
Practice Address - Country:US
Practice Address - Phone:337-462-1315
Practice Address - Fax:337-462-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1833622Medicaid