Provider Demographics
NPI:1629075619
Name:WILLIAMS, DARREN RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:RAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 IRWINS GATE DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3672
Mailing Address - Country:US
Mailing Address - Phone:901-861-2750
Mailing Address - Fax:
Practice Address - Street 1:1100 POPLAR VIEW LN N
Practice Address - Street 2:SUITE 1
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9323
Practice Address - Country:US
Practice Address - Phone:901-854-4422
Practice Address - Fax:901-854-4420
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS53591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN874338OtherUNITED CONCORDIA NUMBER
TN3062952OtherBLUECROSS/BLUESHIELD ID
TN3062952OtherBLUECROSS/BLUESHIELD ID
TN3205667Medicare ID - Type UnspecifiedMEDICARE NUMBER