=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598774218
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL J WILLIAMS, DMD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 06/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 SOUTH ST
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-442-7855
-----------------------------------------------------
Fax | 413-499-3605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 SOUTH ST
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-442-7855
-----------------------------------------------------
Fax | 413-499-3605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL JEFFREY WILLIAMS
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 413-442-7855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 20171
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------