MEDICARE: MS. DIANA M WILLIAMS RDH

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	124Q00000X	Dental Hygienist	2755	CO

General Provider Information

NPI Number	:	1396951281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA M WILLIAMS RDH

Provider Business Mailing Address
First Line	:	1225 IRIS CT
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-2750
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W COUNTY LINE RD STE 240
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-2342
Country	:	US
Telephone Number	:	303-791-6900
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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