MEDICARE: BRIAN D 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	1223G0001X	General Practice Dentistry	26572	TX

General Provider Information

NPI Number	:	1710271457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN D WILLIAMS DDS

Provider Business Mailing Address
First Line	:	4929 SENECA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-2217
Country	:	US
Telephone Number	:	210-296-4989
Fax Number	:

Provider Business Practice Location Address
First Line	:	639 SHERRY LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-4018
Country	:	US
Telephone Number	:	817-737-7711
Fax Number	:

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

Provider Enumeration Date	:	05/29/2011
Last Update Date	:	05/29/2011

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