Provider Demographics
NPI:1265735765
Name:WILLIAMS, AMY LOUISE (RDH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
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 1:126 LELAND ST
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4259
Mailing Address - Country:US
Mailing Address - Phone:301-609-0893
Mailing Address - Fax:
Practice Address - Street 1:126 LELAND ST
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4259
Practice Address - Country:US
Practice Address - Phone:301-609-0893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402203843124Q00000X
MS2833-95DH124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist