Healthcare Provider Details

I. General information

NPI: 1083418909
Provider Name (Legal Business Name): MICHAEL JOSEPH WILLIAMS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 GRAVES ST
CLAYTON NY
13624-1503
US

IV. Provider business mailing address

775 GRAVES ST
CLAYTON NY
13624-1503
US

V. Phone/Fax

Practice location:
  • Phone: 315-686-5142
  • Fax:
Mailing address:
  • Phone: 315-686-5142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number065442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: