Healthcare Provider Details

I. General information

NPI: 1659633782
Provider Name (Legal Business Name): ANGELA M WILLIAMS DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11005 W 60TH ST STE 180
SHAWNEE KS
66203-2716
US

IV. Provider business mailing address

6816 N MADISON AVE
KANSAS CITY MO
64118-1038
US

V. Phone/Fax

Practice location:
  • Phone: 913-631-0110
  • Fax:
Mailing address:
  • Phone: 816-807-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2011015322
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number61098
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: