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General NPI Number Information
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NPI Number | 1467785451
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Entity Type | Organization
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Legal Business Name | WILLIAMS FAMILY DENTISTRY
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 372 CORAL RD
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City | MALVERN
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State | AR
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Zip | 72104-7108
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Country | US
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Telephone | 501-337-9212
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Fax | 501-337-0280
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | MALVERN
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State | AR
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Zip | 72104-0278
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Country | US
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Telephone | 501-337-9212
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Fax | 501-337-0280
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NICHOLAS M FREEMAN
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Credential |
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Telephone | 501-337-9212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2031
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License Number State | AR
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