Provider Demographics
NPI:1922782218
Name:LEONARD DAVID WILLIAMS IV DDS-PC
Entity Type:Organization
Organization Name:LEONARD DAVID WILLIAMS IV DDS-PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-323-7933
Mailing Address - Street 1:621A N FODALE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-3550
Mailing Address - Country:US
Mailing Address - Phone:910-457-5026
Mailing Address - Fax:
Practice Address - Street 1:621A N FODALE AVE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-3550
Practice Address - Country:US
Practice Address - Phone:910-457-5026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental