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NPI Code Detail

MEDICARE: MS. JACQUELINE MAXINE WILLIAMS D.D.S

MEDICARE: MS. JACQUELINE MAXINE 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
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice DentistryDEN1001184DC
3122300000XDentistDEN1001184DC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457651580
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE MAXINE WILLIAMS D.D.S
Provider Business Mailing Address
First Line : 4 ATLANTIC ST SW
Second Line : DENTAL OFFICE
City : WASHINGTON
State : DC
Zip : 20032-2350
Country : US
Telephone Number : 202-540-9857
Fax Number : 202-232-8494
Provider Business Practice Location Address
First Line : 4 ATLANTIC ST SW
Second Line : DENTAL OFFICE
City : WASHINGTON
State : DC
Zip : 20032-2350
Country : US
Telephone Number : 202-540-9857
Fax Number : 202-540-9857
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2010
Last Update Date : 03/28/2014

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