MEDICARE: CRAIG A WILLIAMS D.D.S

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	4395	LA

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	:	1962465302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG A WILLIAMS D.D.S

Provider Business Mailing Address
First Line	:	913 WILLIAMS BLVD
Second Line	:
City	:	KENNER
State	:	LA
Zip	:	70062-6707
Country	:	US
Telephone Number	:	504-469-7576
Fax Number	:	504-463-3208

Provider Business Practice Location Address
First Line	:	913 WILLIAMS BLVD
Second Line	:
City	:	KENNER
State	:	LA
Zip	:	70062-6707
Country	:	US
Telephone Number	:	504-469-7576
Fax Number	:	504-463-3208

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	12/15/2014

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