Healthcare Provider Details

I. General information

NPI: 1679171813
Provider Name (Legal Business Name): DESOTO HAPPY TEETH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N HAMPTON RD
DESOTO TX
75115-4509
US

IV. Provider business mailing address

701 N HAMPTON RD
DESOTO TX
75115-4509
US

V. Phone/Fax

Practice location:
  • Phone: 972-230-0155
  • Fax: 972-230-0741
Mailing address:
  • Phone: 972-230-0155
  • Fax: 972-230-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHARLES IVAN WILLIAMS SR.
Title or Position: DENTIST
Credential: DDS
Phone: 972-230-0155