Provider Demographics
NPI:1871788539
Name:WILLIAMS, JON W JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:W
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5969 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2247
Mailing Address - Country:US
Mailing Address - Phone:703-960-1160
Mailing Address - Fax:703-960-3939
Practice Address - Street 1:5969 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2247
Practice Address - Country:US
Practice Address - Phone:703-960-1160
Practice Address - Fax:703-960-3939
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice