Provider Demographics
NPI:1457416083
Name:TAYLOR-WILLIAMS, VERONICA LATRELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:LATRELLE
Last Name:TAYLOR-WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7327
Mailing Address - Country:US
Mailing Address - Phone:910-355-0300
Mailing Address - Fax:910-355-0301
Practice Address - Street 1:47 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7327
Practice Address - Country:US
Practice Address - Phone:910-355-0300
Practice Address - Fax:910-355-0301
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902EUMedicaid