Healthcare Provider Details

I. General information

NPI: 1508965989
Provider Name (Legal Business Name): WARREN R MCWILLIAMS III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5931 STANLEY AVE STE 3
CARMICHAEL CA
95608-3846
US

IV. Provider business mailing address

5931 STANLEY AVE STE 3
CARMICHAEL CA
95608-3846
US

V. Phone/Fax

Practice location:
  • Phone: 916-972-1933
  • Fax: 916-972-8614
Mailing address:
  • Phone: 916-972-1933
  • Fax: 916-972-8614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number34384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: