Healthcare Provider Details

I. General information

NPI: 1942458286
Provider Name (Legal Business Name): BENJAMIN D WILLIAMS DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 GOLDEN SPRINGS ROAD
ANNISTON AL
36207
US

IV. Provider business mailing address

1715 GOLDEN SPRINGS ROAD
ANNISTON AL
36207
US

V. Phone/Fax

Practice location:
  • Phone: 256-231-0077
  • Fax: 256-231-0866
Mailing address:
  • Phone: 256-231-0077
  • Fax: 256-231-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberAL4736
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number4736
License Number StateAL

VIII. Authorized Official

Name: BENJAMIN D WILLIAMS
Title or Position: OWNER
Credential: DMD
Phone: 256-231-0077