Provider Demographics
NPI:1669480174
Name:WILLIAMS, BILLY DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:DEAN
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 1:2905 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-5208
Mailing Address - Country:US
Mailing Address - Phone:228-769-8521
Mailing Address - Fax:228-762-2820
Practice Address - Street 1:2905 14TH ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-5208
Practice Address - Country:US
Practice Address - Phone:228-769-8521
Practice Address - Fax:228-762-2820
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1333-681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS190000179Medicare ID - Type UnspecifiedPROVIDER ID