Healthcare Provider Details

I. General information

NPI: 1366022451
Provider Name (Legal Business Name): DALLIN JAY WILLIAMS DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S SHERWOOD VILLAGE DR
TUCSON AZ
85710-5957
US

IV. Provider business mailing address

1111 S SHERWOOD VILLAGE DR
TUCSON AZ
85710-5957
US

V. Phone/Fax

Practice location:
  • Phone: 520-886-0466
  • Fax:
Mailing address:
  • Phone: 520-886-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DALLIN JAY WILLIAMS
Title or Position: OWNER
Credential: DDS
Phone: 520-886-0466