MEDICARE: GABRIELLE VICTORIA 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	1223G0001X	General Practice Dentistry	8107	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9022U	OTHER		BLUE CROSS BLUE SHIELD NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568579282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE VICTORIA WILLIAMS DDS

Provider Business Mailing Address
First Line	:	8823 UNIVERSITY EAST DRIVE
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5147
Country	:	US
Telephone Number	:	704-569-8949
Fax Number	:	704-596-8185

Provider Business Practice Location Address
First Line	:	8823 UNIVERSITY EAST DR
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4207
Country	:	US
Telephone Number	:	704-569-8949
Fax Number	:	704-596-8185

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/03/2011

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