Provider Demographics
NPI:1952766487
Name:F STAN WILLIAMS DDS LLC
Entity Type:Organization
Organization Name:F STAN WILLIAMS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREEMAN
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-335-5700
Mailing Address - Street 1:2502 WILLIAM ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5763
Mailing Address - Country:US
Mailing Address - Phone:573-335-5700
Mailing Address - Fax:573-803-1709
Practice Address - Street 1:2502 WILLIAM ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5763
Practice Address - Country:US
Practice Address - Phone:573-335-5700
Practice Address - Fax:573-803-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0150471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty