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General NPI Number Information
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NPI Number | 1710268669
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Entity Type | Organization
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Legal Business Name | MICHAEL O. WILLIAMS, D.D.S.,P.A.
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 424 COURTHOUSE RD
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City | GULFPORT
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State | MS
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Zip | 39507-1849
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Country | US
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Telephone | 228-896-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 424 COURTHOUSE RD
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City | GULFPORT
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State | MS
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Zip | 39507-1849
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Country | US
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Telephone | 228-896-8333
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST DIRECTOR
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Name | DR. MICHAEL OWEN WILLIAMS
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Credential | D.D.S.
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Telephone | 228-896-8333
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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 | 1738-76
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License Number State | MS
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