Provider Demographics
NPI:1235300872
Name:WILLIAMS DENTAL ASSOCIATES SOUTH,PC
Entity type:Organization
Organization Name:WILLIAMS DENTAL ASSOCIATES SOUTH,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-842-5707
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:FERRIS
Mailing Address - State:TX
Mailing Address - Zip Code:75125-0462
Mailing Address - Country:US
Mailing Address - Phone:972-842-5707
Mailing Address - Fax:972-842-5324
Practice Address - Street 1:201 E 5TH ST
Practice Address - Street 2:
Practice Address - City:FERRIS
Practice Address - State:TX
Practice Address - Zip Code:75125-2223
Practice Address - Country:US
Practice Address - Phone:972-842-2248
Practice Address - Fax:972-544-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty