MEDICARE: HALLIE WILLIAMS D.D.S.

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	037076	NY

General Provider Information

NPI Number	:	1194731182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLIE WILLIAMS D.D.S.

Provider Business Mailing Address
First Line	:	1 TUCK RD
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-3501
Country	:	US
Telephone Number	:	845-354-6369
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 5TH AVE
Second Line	:	SUITE 725
City	:	NEW YORK
State	:	NY
Zip	:	10010-7002
Country	:	US
Telephone Number	:	212-229-0617
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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