Provider Demographics
NPI:1831281617
Name:WILLIAMS, DWIGHT (DMD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:
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 1:1600 20TH STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-212-5600
Mailing Address - Fax:205-212-5610
Practice Address - Street 1:1333 19TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35324
Practice Address - Country:US
Practice Address - Phone:205-322-8288
Practice Address - Fax:205-328-8786
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51525538OtherBCBS
AL631609053Medicaid