Provider Demographics
NPI:1205904851
Name:WILLIAMS, LISA D (RDH)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14941 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PK
Mailing Address - State:IL
Mailing Address - Zip Code:60462
Mailing Address - Country:US
Mailing Address - Phone:708-460-7013
Mailing Address - Fax:
Practice Address - Street 1:6800 S MAIN ST
Practice Address - Street 2:GROVE DENTAL ASSOC
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516
Practice Address - Country:US
Practice Address - Phone:630-969-5350
Practice Address - Fax:630-969-4692
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist