MEDICARE: DR. TIMOTHY 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	1223G0001X	General Practice Dentistry	15763	TX

General Provider Information

NPI Number	:	1558448902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY WILLIAMS D.D.S.

Provider Business Mailing Address
First Line	:	4221 85TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-1931
Country	:	US
Telephone Number	:	806-794-4500
Fax Number	:	806-794-6400

Provider Business Practice Location Address
First Line	:	4221 85TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-1931
Country	:	US
Telephone Number	:	806-794-4500
Fax Number	:	806-794-6400

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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