Provider Demographics
NPI:1851844260
Name:WILLIAMSON, MARK JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3355 CHERRY RIDGE ST STE 216
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4818
Mailing Address - Country:US
Mailing Address - Phone:512-689-9174
Mailing Address - Fax:
Practice Address - Street 1:8210 FLOYD CURL DRIVE, MSC 8103
Practice Address - Street 2:UT HEALTH SCIENCE CENTER AT SAN ANTONIO
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-450-3273
Practice Address - Fax:210-450-2223
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXETN424390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program