Provider Demographics
NPI:1770010100
Name:NATHAN D. WILLIAMSON, D.M.D. LLC
Entity Type:Organization
Organization Name:NATHAN D. WILLIAMSON, D.M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-281-7300
Mailing Address - Street 1:240 ADMIRAL TROST RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2163
Mailing Address - Country:US
Mailing Address - Phone:618-400-0550
Mailing Address - Fax:618-400-0824
Practice Address - Street 1:240 ADMIRAL TROST RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2163
Practice Address - Country:US
Practice Address - Phone:618-400-0550
Practice Address - Fax:618-400-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190277471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1770010100OtherNPI
IL1366864589OtherDR. MATTHEW HAARMANN