Healthcare Provider Details

I. General information

NPI: 1619009933
Provider Name (Legal Business Name): CHRISTINE L. WILLIAMS DENTAL HYGIENIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DETROIT HEALTH DEPT. - HERMAN KIEFER HEALTH COMPLEX 1151 TAYLOR STREET, ADULT DENTAL CLINIC , WING 1C
DETROIT MI
48202-1732
US

IV. Provider business mailing address

4890 MARSEILLES ST
DETROIT MI
48224-1451
US

V. Phone/Fax

Practice location:
  • Phone: 313-876-4164
  • Fax: 313-876-0177
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902011188
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: