Provider Demographics
NPI:1720159262
Name:ROBERT L WILLIAMSON III DDS2
Entity Type:Organization
Organization Name:ROBERT L WILLIAMSON III DDS2
Other - Org Name:RALEIGH COMPREHENSIVE & COSMETIC DENTISTRY CAMERON VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-755-3748
Mailing Address - Street 1:119-B N BOYLAN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1422
Mailing Address - Country:US
Mailing Address - Phone:919-755-3748
Mailing Address - Fax:919-828-4937
Practice Address - Street 1:119 N BOYLAN AVE
Practice Address - Street 2:B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1422
Practice Address - Country:US
Practice Address - Phone:919-755-3748
Practice Address - Fax:919-828-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7038122300000X
NC9144122300000X
NC9316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902123Medicaid
NC5919352Medicaid
NC89902EJMedicaid
NC5919352Medicaid
NC1376556787Medicare UPIN
NC1720159262Medicare UPIN
NC1053673939Medicare UPIN