MEDICARE: JEREMY VINCENT WILLIAMS

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	122300000X	Dentist	7143	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7143	OTHER	LA	PRIVATE INSURANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871191817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY VINCENT WILLIAMS

Provider Business Mailing Address
First Line	:	2724 WOODMERE BLVD
Second Line	:
City	:	HARVEY
State	:	LA
Zip	:	70058-2031
Country	:	US
Telephone Number	:	504-495-5844
Fax Number	:

Provider Business Practice Location Address
First Line	:	7023 READ LN
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2366
Country	:	US
Telephone Number	:	504-244-0177
Fax Number	:

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/12/2020

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Directions to “ JEREMY VINCENT WILLIAMS ” Practice Location

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