Healthcare Provider Details

I. General information

NPI: 1720159262
Provider Name (Legal Business Name): ROBERT L WILLIAMSON III DDS2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N BOYLAN AVE B
RALEIGH NC
27603-1422
US

IV. Provider business mailing address

119-B N BOYLAN AVE
RALEIGH NC
27603-1422
US

V. Phone/Fax

Practice location:
  • Phone: 919-755-3748
  • Fax: 919-828-4937
Mailing address:
  • Phone: 919-755-3748
  • Fax: 919-828-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9144
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9316
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7038
License Number StateNC

VIII. Authorized Official

Name: MS. NANCY CAMPBELL
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 919-755-3748