Healthcare Provider Details

I. General information

NPI: 1063584282
Provider Name (Legal Business Name): ROBERT L WILLIAMSON, III, DDS3, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 PRINCESS ST
WILMINGTON NC
28401-3848
US

IV. Provider business mailing address

1624 PRINCESS ST
WILMINGTON NC
28401-3848
US

V. Phone/Fax

Practice location:
  • Phone: 910-251-8174
  • Fax: 910-341-3037
Mailing address:
  • Phone: 910-251-8174
  • Fax: 910-341-3037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7986
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8411
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8852
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number260100
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7038
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8999
License Number StateNC

VIII. Authorized Official

Name: NANCY CAMPBELL
Title or Position: REGIONAL MANAGER
Credential:
Phone: 919-624-7207