Provider Demographics
NPI:1013105451
Name:WILLIAMS, MICHAEL OWEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:OWEN
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:PO BOX 8333
Mailing Address - Street 2:424 COURT HOUSE ROAD
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1849
Mailing Address - Country:US
Mailing Address - Phone:228-896-8333
Mailing Address - Fax:228-896-8335
Practice Address - Street 1:424 COURT HOUSE ROAD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1849
Practice Address - Country:US
Practice Address - Phone:228-896-8333
Practice Address - Fax:228-896-8335
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOR19801223X0400X
CA1738761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics