Healthcare Provider Details

I. General information

NPI: 1700860160
Provider Name (Legal Business Name): STEPHEN B WILLIAMS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AFIP, 6825 16TH ST NW BLDG 54, RM 3055
WASHINGTON DC
20306-0001
US

IV. Provider business mailing address

1914 ELKHART ST
SILVER SPRING MD
20910-2153
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-1800
  • Fax:
Mailing address:
  • Phone: 301-587-6067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number18404
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: