Provider Demographics
NPI:1821105867
Name:WILLIAMS, MARK N (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:N
Last Name:WILLIAMS
Suffix:
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 1:804-I EASTWOOD CENTER
Mailing Address - Street 2:PO BOX 627
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-0627
Mailing Address - Country:US
Mailing Address - Phone:217-586-3535
Mailing Address - Fax:217-586-3586
Practice Address - Street 1:EASTWOOD DRIVE
Practice Address - Street 2:804-I EASTWOOD CENTER
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-0627
Practice Address - Country:US
Practice Address - Phone:217-586-3535
Practice Address - Fax:217-586-3586
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-162611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice