Healthcare Provider Details

I. General information

NPI: 1801913207
Provider Name (Legal Business Name): WILLIAMS, SCHEIDEMAN & RUNYON, DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 OAK PARK LN
FORT WORTH TX
76109-1512
US

IV. Provider business mailing address

4300 OAK PARK LN
FORT WORTH TX
76109-1512
US

V. Phone/Fax

Practice location:
  • Phone: 817-731-2789
  • Fax: 817-207-9980
Mailing address:
  • Phone: 817-731-2789
  • Fax: 817-207-9980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7817
License Number StateTX

VIII. Authorized Official

Name: DR. WALTER GIBBE WILLIAMS
Title or Position: PRESIDENT
Credential: DDS
Phone: 817-731-2789