MEDICARE: DR. GERALD ALAN WILLIAMS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	LA2386	LA

General Provider Information

NPI Number	:	1114929262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD ALAN WILLIAMS DDS

Provider Business Mailing Address
First Line	:	109 ONDINE LN
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70458-9007
Country	:	US
Telephone Number	:	504-453-9757
Fax Number	:	985-847-9177

Provider Business Practice Location Address
First Line	:	2790 GAUSE BLVD E STE 1
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-4246
Country	:	US
Telephone Number	:	985-649-9359
Fax Number	:	985-649-9839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/23/2012

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