Provider Demographics
NPI:1710187091
Name:WILLIAMS, GEORGE A JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4002
Mailing Address - Country:US
Mailing Address - Phone:212-939-9399
Mailing Address - Fax:212-939-9366
Practice Address - Street 1:706 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4002
Practice Address - Country:US
Practice Address - Phone:212-939-9399
Practice Address - Fax:212-939-9366
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist