Healthcare Provider Details

I. General information

NPI: 1518942432
Provider Name (Legal Business Name): MARY NIKOLE WILLIAMS-TREESH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E PENNSYLVANIA AVE STE 1
ESCONDIDO CA
92025-3432
US

IV. Provider business mailing address

925 E PENNSYLVANIA AVE STE 1
ESCONDIDO CA
92025-3432
US

V. Phone/Fax

Practice location:
  • Phone: 760-743-7176
  • Fax:
Mailing address:
  • Phone: 607-437-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8212
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number105130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: