Provider Demographics
NPI:1265550156
Name:WILLIAMS, BENJAMIN ALLEN (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-4128
Mailing Address - Country:US
Mailing Address - Phone:336-886-4161
Mailing Address - Fax:336-886-8372
Practice Address - Street 1:319 N COLLEGE DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-4128
Practice Address - Country:US
Practice Address - Phone:336-886-4161
Practice Address - Fax:336-886-8372
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3741OtherLICENSE #
NC8999302Medicaid