Provider Demographics
NPI:1700915550
Name:WILLIAMS, WILLIE GOLDEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:GOLDEN
Last Name:WILLIAMS
Suffix:
Gender:M
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:PO BOX 1815
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-1815
Mailing Address - Country:US
Mailing Address - Phone:337-942-3390
Mailing Address - Fax:337-942-8644
Practice Address - Street 1:8762 HIGHWAY 182
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5603
Practice Address - Country:US
Practice Address - Phone:337-942-2005
Practice Address - Fax:337-942-8644
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1856096Medicaid