Healthcare Provider Details

I. General information

NPI: 1891989299
Provider Name (Legal Business Name): LAWRENCE SAMUEL WILLIAMS JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LARRY WILLIAMS D.M.D.

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PRISON ROAD FED CORR INST ESTILL
ESTILL SC
29918-0699
US

IV. Provider business mailing address

PO BOX 699 FED CORR INST ESTILL
ESTILL SC
29918-0699
US

V. Phone/Fax

Practice location:
  • Phone: 803-625-4607
  • Fax: 803-625-5636
Mailing address:
  • Phone: 803-625-4607
  • Fax: 803-625-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: