Provider Demographics
NPI:1912392317
Name:CASEY J WILLIAMS, DMD
Entity Type:Organization
Organization Name:CASEY J WILLIAMS, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-258-3858
Mailing Address - Street 1:P.O. BOX 87
Mailing Address - Street 2:210 FORGE RD SUITE 1
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17007
Mailing Address - Country:US
Mailing Address - Phone:717-258-3858
Mailing Address - Fax:717-258-8458
Practice Address - Street 1:210 FORGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BOILING SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17007
Practice Address - Country:US
Practice Address - Phone:717-258-3858
Practice Address - Fax:717-258-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS29104122300000X
PA39948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty