Provider Demographics
NPI:1972623775
Name:WILLIAMS, RICHARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:875 UNION AVE S-301
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-4790
Mailing Address - Country:US
Mailing Address - Phone:901-448-6210
Mailing Address - Fax:901-448-8358
Practice Address - Street 1:399 SOUTHCREST CT
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4790
Practice Address - Country:US
Practice Address - Phone:662-349-2196
Practice Address - Fax:662-349-8349
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS 2039-831223X0400X
TN45691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics