Provider Demographics
NPI:1942458286
Name:BENJAMIN D WILLIAMS DENTAL GROUP LLC
Entity Type:Organization
Organization Name:BENJAMIN D WILLIAMS DENTAL GROUP LLC
Other - Org Name:SHANNON R THOMAS DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-231-0077
Mailing Address - Street 1:1715 GOLDEN SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207
Mailing Address - Country:US
Mailing Address - Phone:256-231-0077
Mailing Address - Fax:256-231-0866
Practice Address - Street 1:1715 GOLDEN SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207
Practice Address - Country:US
Practice Address - Phone:256-231-0077
Practice Address - Fax:256-231-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL47361223P0300X
AL4736261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-10222OtherBLUE CROSS BLUE SHIELD OF AL