Healthcare Provider Details

I. General information

NPI: 1548271968
Provider Name (Legal Business Name): MICHAEL SCOTT WILLIAMSON D.D.S.,M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7200 N MO PAC EXPY STE 210
AUSTIN TX
78731-2698
US

IV. Provider business mailing address

7200 N MO PAC EXPY STE 210
AUSTIN TX
78731-2698
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-2782
  • Fax: 512-346-7284
Mailing address:
  • Phone: 512-346-2782
  • Fax: 512-346-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: