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General NPI Number Information
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NPI Number | 1518904259
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Entity Type | Individual
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Provider Name | LARRY S WILLIAMS DDS
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 115 BUSINESS LOOP 70 W
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City | COLUMBIA
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State | MO
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Zip | 65203-3244
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Country | US
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Telephone | 573-884-6253
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Fax | 573-884-5390
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Provider Business Mailing Address
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Address Line | PO BOX 7687
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City | COLUMBIA
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State | MO
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Zip | 65205-7687
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Country | US
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Telephone | 573-882-2259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE011674
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License Number State | MO
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