Provider Demographics
NPI:1659524916
Name:WILLIAMS, JODY LYNN
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 ALABAMA ST
Mailing Address - Street 2:#A
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-4603
Mailing Address - Country:US
Mailing Address - Phone:360-594-4259
Mailing Address - Fax:360-738-6651
Practice Address - Street 1:1301 ALABAMA ST
Practice Address - Street 2:#A
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-4603
Practice Address - Country:US
Practice Address - Phone:360-594-4259
Practice Address - Fax:360-738-6651
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122300000X122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist