MEDICARE: WILLIAMS & TATE LLC

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	DS030800R	PA

General Provider Information

NPI Number	:	1902943525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMS & TATE LLC

Provider Business Mailing Address
First Line	:	1254 E. EARL RD
Second Line	:
City	:	EAST EARL
State	:	PA
Zip	:	17519
Country	:	US
Telephone Number	:	717-354-7904
Fax Number	:	717-354-0754

Provider Business Practice Location Address
First Line	:	1254 E. EARL RD
Second Line	:
City	:	EAST EARL
State	:	PA
Zip	:	17519
Country	:	US
Telephone Number	:	717-354-7904
Fax Number	:	717-354-0754

Authorized Official
Title or Position	:	SR. OFFICE COORDINATOR
Name	:	MAE HIGH
Credential	:
Telephone Number	:	717-354-7904

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2020

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Directions to “WILLIAMS & TATE LLC ” Practice Location

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