Provider Demographics
NPI:1750595971
Name:WILLIAMS, KATHLEEN (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11938 COUNTY ROAD 101
Mailing Address - Street 2:SUITE 130
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-9330
Mailing Address - Country:US
Mailing Address - Phone:352-391-9930
Mailing Address - Fax:
Practice Address - Street 1:11938 COUNTY ROAD 101
Practice Address - Street 2:SUITE 130
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9330
Practice Address - Country:US
Practice Address - Phone:352-391-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice