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General NPI Number Information
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NPI Number | 1881260271
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Entity Type | Individual
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Provider Name | COREY JERROD WILLIAMS DMD
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Gender | Male
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 2323 BABCOCK RD
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5066
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Country | US
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Telephone | 210-839-1899
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Fax |
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Provider Business Mailing Address
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Address Line | 683 HAZELTON DR
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City | MADISON
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State | MS
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Zip | 39110-7390
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Country | US
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Telephone | 281-686-7547
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 27802
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS-09888
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40733
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License Number State | TX
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