MEDICARE: MARCUS ORENE WILLIAMS III DMD

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	4827	FL

General Provider Information

NPI Number	:	1477712461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS ORENE WILLIAMS III DMD

Provider Business Mailing Address
First Line	:	201 MAITLAND AVE
Second Line	:	1013
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4903
Country	:	US
Telephone Number	:	407-834-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 MAITLAND AVE
Second Line	:	1013
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4903
Country	:	US
Telephone Number	:	407-834-0330
Fax Number	:

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

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	06/04/2008

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