Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1104430677 |
---|---|
Provider Name | Austin Wayne Williams |
First Address | Fort Myer, VA 22211-1009 |
Second Address | Fort Myer, VA 22211-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2020 |
Last Update Date | 02/09/2020 |