Provider Demographics
NPI:1881260271
Name:WILLIAMS, COREY JERROD (DMD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:JERROD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:COREY
Other - Middle Name:JERROD
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:683 HAZELTON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7390
Mailing Address - Country:US
Mailing Address - Phone:281-686-7547
Mailing Address - Fax:
Practice Address - Street 1:2323 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5066
Practice Address - Country:US
Practice Address - Phone:210-839-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27802122300000X
IADDS-09888122300000X
TX407331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist