Provider Demographics
NPI:1134147903
Name:WILLIAMS, KELLY S (DMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 BODLE RD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-6016
Mailing Address - Country:US
Mailing Address - Phone:570-410-1035
Mailing Address - Fax:
Practice Address - Street 1:328 BODLE RD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-6016
Practice Address - Country:US
Practice Address - Phone:570-410-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0352451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice