Healthcare Provider Details

I. General information

NPI: 1689763005
Provider Name (Legal Business Name): ARTHUR E WILLIAMS II D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25101 COOLIDGE HWY
OAK PARK MI
48237-1404
US

IV. Provider business mailing address

PO BOX 35350
DETROIT MI
48235-0350
US

V. Phone/Fax

Practice location:
  • Phone: 313-838-0480
  • Fax: 313-838-4974
Mailing address:
  • Phone: 313-838-0480
  • Fax: 313-924-8262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12594
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number24152
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: