Provider Demographics
NPI:1780692376
Name:WILLIAMS, CHARLES IVAN SR (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:IVAN
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3001 KNOX ST
Mailing Address - Street 2:SUITE #300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5584
Mailing Address - Country:US
Mailing Address - Phone:214-265-7771
Mailing Address - Fax:214-219-1098
Practice Address - Street 1:3001 KNOX ST
Practice Address - Street 2:SUITE #300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5584
Practice Address - Country:US
Practice Address - Phone:214-265-7771
Practice Address - Fax:214-219-1098
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX84951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice