Provider Demographics
NPI:1760835508
Name:WILLIAMSON, ALEXA RICHTMYER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:RICHTMYER
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-5018
Mailing Address - Country:US
Mailing Address - Phone:843-572-9909
Mailing Address - Fax:
Practice Address - Street 1:6035 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-5018
Practice Address - Country:US
Practice Address - Phone:843-572-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD 87561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice