Provider Demographics
NPI:1841466653
Name:WILLIAMS, DONNA R (DDS)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W 125TH ST
Mailing Address - Street 2:#7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4801
Mailing Address - Country:US
Mailing Address - Phone:212-864-7224
Mailing Address - Fax:
Practice Address - Street 1:360 W 125TH ST
Practice Address - Street 2:#7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4801
Practice Address - Country:US
Practice Address - Phone:212-864-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY45104-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice