Provider Demographics
NPI:1750430161
Name:WILLIAMS, JAMES MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2676 CHARLESTOWN RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2574
Mailing Address - Country:US
Mailing Address - Phone:812-945-5533
Mailing Address - Fax:812-945-0557
Practice Address - Street 1:2676 CHARLESTOWN RD
Practice Address - Street 2:SUITE #1
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2574
Practice Address - Country:US
Practice Address - Phone:812-945-5533
Practice Address - Fax:812-945-0557
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010335A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200336920AMedicaid