Provider Demographics
NPI:1922358670
Name:WILLIAMS, DALE JR
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 ALVIS CIR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-6869
Mailing Address - Country:US
Mailing Address - Phone:505-459-9403
Mailing Address - Fax:505-873-1172
Practice Address - Street 1:6150 ALVIS CIR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-6869
Practice Address - Country:US
Practice Address - Phone:505-459-9403
Practice Address - Fax:505-873-1172
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor