Healthcare Provider Details

I. General information

NPI: 1376909721
Provider Name (Legal Business Name): WILLIAMS SMITH HAWKINS ET AL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19501 E US HIGHWAY 40
INDEPENDENCE MO
64055-5475
US

IV. Provider business mailing address

19501 E US HIGHWAY 40
INDEPENDENCE MO
64055-5475
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-9500
  • Fax: 816-795-9501
Mailing address:
  • Phone: 816-795-9500
  • Fax: 816-795-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number23533
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW WILEY
Title or Position: PRESIDENT
Credential: DDS
Phone: 816-795-9500