Healthcare Provider Details

I. General information

NPI: 1770770794
Provider Name (Legal Business Name): KEITH T WILLIAMS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 DELK RD SE STE 420
MARIETTA GA
30067-5320
US

IV. Provider business mailing address

2900 DELK RD SE STE 420
MARIETTA GA
30067-5320
US

V. Phone/Fax

Practice location:
  • Phone: 248-943-4817
  • Fax:
Mailing address:
  • Phone: 770-790-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN015235
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN015235
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: