Provider Demographics
NPI:1174620785
Name:WILLIAMS, DONNA RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:RAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 E 42ND ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762
Mailing Address - Country:US
Mailing Address - Phone:432-368-5209
Mailing Address - Fax:432-368-4742
Practice Address - Street 1:3800 E 42ND ST
Practice Address - Street 2:SUITE 302
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762
Practice Address - Country:US
Practice Address - Phone:432-368-5209
Practice Address - Fax:432-368-4742
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist