Provider Demographics
NPI:1962465302
Name:WILLIAMS, CRAIG A (DDS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:WILLIAMS
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 1:913 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-6707
Mailing Address - Country:US
Mailing Address - Phone:504-469-7576
Mailing Address - Fax:504-463-3208
Practice Address - Street 1:913 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-6707
Practice Address - Country:US
Practice Address - Phone:504-469-7576
Practice Address - Fax:504-463-3208
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1843954Medicaid