MEDICARE: DR. PATRICK WILLIAMS D.M.D.

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	122300000X	Dentist	DN15764	FL

General Provider Information

NPI Number	:	1124275888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK WILLIAMS D.M.D.

Provider Business Mailing Address
First Line	:	731 DUNLAWTON AVE
Second Line	:	STE. # 102
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4236
Country	:	US
Telephone Number	:	386-767-6636
Fax Number	:	386-767-5879

Provider Business Practice Location Address
First Line	:	731 DUNLAWTON AVE
Second Line	:	STE. # 102
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4236
Country	:	US
Telephone Number	:	386-767-6636
Fax Number	:	386-767-5879

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

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	08/25/2008

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