MEDICARE: DR. JAMES M. WILLIAMSON D.M.D

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	1223G0001X	General Practice Dentistry	15576	UT

General Provider Information

NPI Number	:	1497881361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M. WILLIAMSON D.M.D

Provider Business Mailing Address
First Line	:	622 E 4500 S
Second Line	:	SUITE 201
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2921
Country	:	US
Telephone Number	:	801-266-9582
Fax Number	:	801-266-9542

Provider Business Practice Location Address
First Line	:	622 E 4500 S
Second Line	:	SUITE 201
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2921
Country	:	US
Telephone Number	:	801-266-9582
Fax Number	:	801-266-9542

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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