Healthcare Provider Details

I. General information

NPI: 1649962937
Provider Name (Legal Business Name): MARSHALL ALLEN WILLIAMS II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MOBILE HWY
MONTGOMERY AL
36108-4027
US

IV. Provider business mailing address

3060 MOBILE HWY
MONTGOMERY AL
36108-4027
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-6670
  • Fax:
Mailing address:
  • Phone: 334-293-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD.007308-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: