Healthcare Provider Details

I. General information

NPI: 1790691004
Provider Name (Legal Business Name): TRACY WILLIAMS, DMD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 BONITA LAKES PLZ STE B
MERIDIAN MS
39301-7017
US

IV. Provider business mailing address

519 BONITA LAKES PLZ STE B
MERIDIAN MS
39301-7017
US

V. Phone/Fax

Practice location:
  • Phone: 601-485-2095
  • Fax:
Mailing address:
  • Phone: 601-485-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TRACY WILLIAMS
Title or Position: OWNER
Credential: DMD
Phone: 601-485-2095