Provider Demographics
NPI:1265792998
Name:WILLIAMS, MICHAEL SEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SEAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1701 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6005
Mailing Address - Country:US
Mailing Address - Phone:910-346-2345
Mailing Address - Fax:910-346-1332
Practice Address - Street 1:1701 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6005
Practice Address - Country:US
Practice Address - Phone:910-346-2345
Practice Address - Fax:910-346-1332
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice