Healthcare Provider Details

I. General information

NPI: 1942475843
Provider Name (Legal Business Name): NOELLE WILLIAMS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 SW ARCHER RD H242A
GAINESVILLE FL
32608-1700
US

IV. Provider business mailing address

3230 SW ARCHER RD H242A
GAINESVILLE FL
32608-1700
US

V. Phone/Fax

Practice location:
  • Phone: 352-275-4212
  • Fax:
Mailing address:
  • Phone: 352-275-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 17723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: