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General NPI Number Information
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NPI Number | 1942458286
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Entity Type | Organization
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Legal Business Name | BENJAMIN D WILLIAMS DENTAL GROUP LLC
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 1715 GOLDEN SPRINGS ROAD
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City | ANNISTON
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State | AL
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Zip | 36207
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Country | US
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Telephone | 256-231-0077
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Fax | 256-231-0866
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Provider Business Mailing Address
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Address Line | 1715 GOLDEN SPRINGS ROAD
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City | ANNISTON
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State | AL
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Zip | 36207
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Country | US
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Telephone | 256-231-0077
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Fax | 256-231-0866
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN D WILLIAMS
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Credential | DMD
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Telephone | 256-231-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4736
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | AL4736
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License Number State | AL
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