Provider Demographics
NPI:1952304867
Name:WILLIAMSON, JON WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:WALTER
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 HICKERSON ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2685
Mailing Address - Country:US
Mailing Address - Phone:972-299-6356
Mailing Address - Fax:972-299-9144
Practice Address - Street 1:263 HICKERSON ST
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2685
Practice Address - Country:US
Practice Address - Phone:972-299-6356
Practice Address - Fax:972-299-9144
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice