Healthcare Provider Details

I. General information

NPI: 1689467524
Provider Name (Legal Business Name): JORDYN MARIE WILLIAMS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WRIGHT PATTERSON AFB OH
45433-5529
US

IV. Provider business mailing address

4950 CORNERSTONE NORTH BLVD UNIT 1309
DAYTON OH
45440-2364
US

V. Phone/Fax

Practice location:
  • Phone: 252-481-4006
  • Fax:
Mailing address:
  • Phone: 252-481-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number14155
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number14155
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number14155
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: