Provider Demographics
NPI:1396973236
Name:WILLIAMS, JONATHAN TRAVIS (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TRAVIS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD,MD
Mailing Address - Street 1:40 ASHBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-8122
Mailing Address - Country:US
Mailing Address - Phone:216-269-9833
Mailing Address - Fax:
Practice Address - Street 1:3545 OLENTANGY RIVER RD STE 125
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3996
Practice Address - Country:US
Practice Address - Phone:614-267-0385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023315122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist