Provider Demographics
NPI:1265539167
Name:WILLIAMS, NORMAN L (DDS)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:L
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 1:1515 NOBLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2354
Mailing Address - Country:US
Mailing Address - Phone:434-572-4585
Mailing Address - Fax:434-572-4372
Practice Address - Street 1:1515 NOBLIN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2354
Practice Address - Country:US
Practice Address - Phone:434-572-4585
Practice Address - Fax:434-572-4372
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7814852Medicaid