Healthcare Provider Details

I. General information

NPI: 1780770073
Provider Name (Legal Business Name): JOE DAN WILLIAMS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 VENTNOR AVE
VENTNOR CITY NJ
08406-2027
US

IV. Provider business mailing address

5 N VENDOME AVE
MARGATE CITY NJ
08402-1241
US

V. Phone/Fax

Practice location:
  • Phone: 609-823-6100
  • Fax:
Mailing address:
  • Phone: 609-487-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI01141300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: