Healthcare Provider Details

I. General information

NPI: 1649631979
Provider Name (Legal Business Name): EBONY WILLIAMS RDH BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W LONG ST
COLUMBUS OH
43215-2815
US

IV. Provider business mailing address

931 ELLINGTON CIR
GAHANNA OH
43230-2291
US

V. Phone/Fax

Practice location:
  • Phone: 614-225-0990
  • Fax:
Mailing address:
  • Phone: 614-806-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31.011312
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: