Provider Demographics
NPI:1710268669
Name:MICHAEL O. WILLIAMS, D.D.S.,P.A.
Entity Type:Organization
Organization Name:MICHAEL O. WILLIAMS, D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:228-896-8333
Mailing Address - Street 1:424 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1849
Mailing Address - Country:US
Mailing Address - Phone:228-896-8333
Mailing Address - Fax:
Practice Address - Street 1:424 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1849
Practice Address - Country:US
Practice Address - Phone:228-896-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1738-761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty