MEDICARE: MATTHEW R 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	DE60217899	WA

General Provider Information

NPI Number	:	1932339702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW R WILLIAMS

Provider Business Mailing Address
First Line	:	1603 GROVE ST
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-4301
Country	:	US
Telephone Number	:	360-651-1882
Fax Number	:	360-651-1889

Provider Business Practice Location Address
First Line	:	1603 GROVE ST
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-4301
Country	:	US
Telephone Number	:	360-651-1882
Fax Number	:	360-651-1889

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

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	04/08/2025

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