Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS019776-L | PA |
NPI | 1003927005 |
---|---|
Provider Name | Dr. Ben Graham Williams |
First Address | Boalsburg, PA 16827-1803 |
Second Address | State College, PA 16801-7640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |