Provider Demographics
NPI:1013633247
Name:WILLIAMS DENTAL P C
Entity type:Organization
Organization Name:WILLIAMS DENTAL P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-344-9800
Mailing Address - Street 1:4302 W CRYSTAL LAKE RD STE J
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4248
Mailing Address - Country:US
Mailing Address - Phone:815-385-0777
Mailing Address - Fax:
Practice Address - Street 1:4302 W CRYSTAL LAKE RD STE J
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4248
Practice Address - Country:US
Practice Address - Phone:815-385-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty