Healthcare Provider Details

I. General information

NPI: 1962511519
Provider Name (Legal Business Name): STEPHANIE S WILLIAMS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MORSE BLVD 102
WINTER PARK FL
32789-4261
US

IV. Provider business mailing address

400 W MORSE BLVD 102
WINTER PARK FL
32789-4261
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-4463
  • Fax: 407-644-4886
Mailing address:
  • Phone: 407-644-4463
  • Fax: 407-644-4886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN13648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: