Provider Demographics
NPI:1245516574
Name:PEDIATRIC DENTISTRY OF SHERMAN, PA
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY OF SHERMAN, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:972-736-1000
Mailing Address - Street 1:275 W PRINCETON DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-9602
Mailing Address - Country:US
Mailing Address - Phone:972-736-1000
Mailing Address - Fax:972-736-1002
Practice Address - Street 1:275 W PRINCETON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-9602
Practice Address - Country:US
Practice Address - Phone:972-736-1000
Practice Address - Fax:972-736-1002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC DENTISTRY OF SHERMAN, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-01
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1316103443Medicaid