Healthcare Provider Details

I. General information

NPI: 1265603823
Provider Name (Legal Business Name): BENJAMIN D. WILLIAMS DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 57TH ST SO
BIRMINGHAM AL
35212
US

IV. Provider business mailing address

100 57TH ST SO
BIRMINGHAM AL
35212
US

V. Phone/Fax

Practice location:
  • Phone: 205-591-1101
  • Fax: 205-592-0142
Mailing address:
  • Phone: 205-591-1101
  • Fax: 205-592-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN WILLIAMS
Title or Position: OWNER
Credential:
Phone: 205-591-1101