Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 1269 | NM |
NPI | 1063430262 |
---|---|
Provider Name | Dr. David S Williams |
First Address | Albuquerque, NM 87111-0000 |
Second Address | Albuquerque, NM 87111-3852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 23/04/2008 |