Provider Demographics
NPI:1003919077
Name:WILLIAMS, DELISA T (DDS)
Entity type:Individual
Prefix:DR
First Name:DELISA
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2167 MEADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5762
Mailing Address - Country:US
Mailing Address - Phone:717-354-7904
Mailing Address - Fax:717-354-0754
Practice Address - Street 1:1254 EAST EARL RD
Practice Address - Street 2:
Practice Address - City:EAST EARL
Practice Address - State:PA
Practice Address - Zip Code:17519-0100
Practice Address - Country:US
Practice Address - Phone:717-354-7904
Practice Address - Fax:717-354-0754
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO3O800R1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice