Provider Demographics
NPI:1851570634
Name:WENDELL A WILLIAMS DDS
Entity Type:Organization
Organization Name:WENDELL A WILLIAMS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-597-0337
Mailing Address - Street 1:5900 SHATTUCK AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-0742
Mailing Address - Country:US
Mailing Address - Phone:510-597-0337
Mailing Address - Fax:510-597-0339
Practice Address - Street 1:5900 SHATTUCK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-0742
Practice Address - Country:US
Practice Address - Phone:510-597-0337
Practice Address - Fax:510-597-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty