MEDICARE: DR. JOHN DAVID WILLIAMS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	3464	AR

General Provider Information

NPI Number	:	1285033621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID WILLIAMS DDS

Provider Business Mailing Address
First Line	:	5305 W VILLAGE PKWY STE 12
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8116
Country	:	US
Telephone Number	:	479-845-7250
Fax Number	:	479-845-7259

Provider Business Practice Location Address
First Line	:	5305 W VILLAGE PKWY STE 12
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8116
Country	:	US
Telephone Number	:	479-845-7250
Fax Number	:	479-845-7259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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