MEDICARE: DR. ROLAND PAUL WILLIAMS DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	59261	CA

General Provider Information

NPI Number	:	1639325731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROLAND PAUL WILLIAMS DDS

Provider Business Mailing Address
First Line	:	PO BOX 970
Second Line	:
City	:	YUCAIPA
State	:	CA
Zip	:	92399-0970
Country	:	US
Telephone Number	:	909-258-9263
Fax Number	:	909-543-4211

Provider Business Practice Location Address
First Line	:	1655 N MOUNT VERNON AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1427
Country	:	US
Telephone Number	:	909-258-9263
Fax Number	:	909-543-4211

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

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	01/31/2011

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