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General NPI Number Information
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NPI Number | 1194093211
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Entity Type | Organization
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Legal Business Name | ZACHARY T WILLIAMS DDS MCLD LLC
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Dates
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Enumeration Date | 12/03/2011
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Last Update Date | 12/03/2011
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Provider Practice Location Address
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Address Line | 10760 E STATE ROUTE 350
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City | RAYTOWN
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State | MO
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Zip | 64138-1815
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Country | US
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Telephone | 816-358-9691
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Fax |
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Provider Business Mailing Address
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Address Line | 10760 E STATE ROUTE 350
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City | RAYTOWN
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State | MO
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Zip | 64138-1815
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Country | US
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Telephone | 816-358-9691
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ZACHARY THOMAS WILLIAMS
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Credential | D.D.S., M.C.L.D.
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Telephone | 816-419-0946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2011003001
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License Number State | MO
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