Healthcare Provider Details

I. General information

NPI: 1437363819
Provider Name (Legal Business Name): JAMES RAYMOND WILLIAMS III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11610 N SAGINAW ST
MOUNT MORRIS MI
48458-2021
US

IV. Provider business mailing address

11610 N SAGINAW ST
MOUNT MORRIS MI
48458-2021
US

V. Phone/Fax

Practice location:
  • Phone: 810-686-8460
  • Fax:
Mailing address:
  • Phone: 810-686-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901013013
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: