MEDICARE: DR. J GARY 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	11236	TX

General Provider Information

NPI Number	:	1760491971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. J GARY WILLIAMS DDS

Provider Business Mailing Address
First Line	:	715 NORTH 64TH STREET
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-4387
Country	:	US
Telephone Number	:	254-772-3922
Fax Number	:	254-776-6230

Provider Business Practice Location Address
First Line	:	715 NORTH 64TH
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-4387
Country	:	US
Telephone Number	:	254-772-3922
Fax Number	:	254-776-6230

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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