=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528120706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVAN THOMAS WILLIAMS DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 W GEORGE ST
-----------------------------------------------------
City | CARMICHAELS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15320-1344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-966-5791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 W GEORGE ST
-----------------------------------------------------
City | CARMICHAELS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15320-1344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-966-5791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS019113L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------