Provider Demographics
NPI:1942431481
Name:ROBERT L. WILLIAMSON, III, DDS5
Entity Type:Organization
Organization Name:ROBERT L. WILLIAMSON, III, DDS5
Other - Org Name:SMITHFIELD COMPREHENSIVE & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-934-3636
Mailing Address - Street 1:415-B NORTH SEVENTH STREET
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577
Mailing Address - Country:US
Mailing Address - Phone:919-934-3636
Mailing Address - Fax:919-934-1667
Practice Address - Street 1:415-B NORTH SEVENTH STREET
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577
Practice Address - Country:US
Practice Address - Phone:919-934-3636
Practice Address - Fax:919-934-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7038122300000X, 122300000X
NC9144122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919352Medicaid
NC5913143Medicaid
NC89902EJMedicaid
NC5920174Medicaid