Provider Demographics
NPI:1891989299
Name:WILLIAMS, LAWRENCE SAMUEL JR (DMD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:SAMUEL
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:FED CORR INST ESTILL
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-0699
Mailing Address - Country:US
Mailing Address - Phone:803-625-4607
Mailing Address - Fax:803-625-5636
Practice Address - Street 1:100 PRISON ROAD
Practice Address - Street 2:FED CORR INST ESTILL
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-0699
Practice Address - Country:US
Practice Address - Phone:803-625-4607
Practice Address - Fax:803-625-5636
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29011223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health