Provider Demographics
NPI:1629296793
Name:WILLIAMS, KEITH ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ALEXANDER
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 1:279 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5727
Mailing Address - Country:US
Mailing Address - Phone:954-975-9779
Mailing Address - Fax:954-975-9778
Practice Address - Street 1:279 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-5727
Practice Address - Country:US
Practice Address - Phone:954-975-9779
Practice Address - Fax:954-975-9778
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL148011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice