Provider Demographics
NPI:1619009933
Name:WILLIAMS, CHRISTINE L (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4890 MARSEILLES ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DETROIT HEALTH DEPT. - HERMAN KIEFER HEALTH COMPLEX
Practice Address - Street 2:1151 TAYLOR STREET, ADULT DENTAL CLINIC , WING 1C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-4164
Practice Address - Fax:313-876-0177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902011188124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist