Provider Demographics
NPI:1669121018
Name:WILLIAMS, ETHELMAY J (RDH)
Entity type:Individual
Prefix:
First Name:ETHELMAY
Middle Name:J
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 1:1312 BRIDGEHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5834
Mailing Address - Country:US
Mailing Address - Phone:719-271-1293
Mailing Address - Fax:
Practice Address - Street 1:1312 BRIDGEHAMPTON DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5834
Practice Address - Country:US
Practice Address - Phone:719-271-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist