MEDICARE: DR. KEITH T 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	1223P0221X	Pediatric Dentistry	DN015235	GA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN015235	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770770794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH T WILLIAMS DDS

Provider Business Mailing Address
First Line	:	2900 DELK RD SE STE 420
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-5320
Country	:	US
Telephone Number	:	770-790-4590
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 DELK RD SE STE 420
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-5320
Country	:	US
Telephone Number	:	248-943-4817
Fax Number	:

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

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	05/19/2026

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