Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 39109 | CA |
NPI | 1013190255 |
---|---|
Provider Name | Dr. Harley Jill Williams |
First Address | Livermore, CA 94550-4002 |
Second Address | Livermore, CA 94550-4002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2007 |
Last Update Date | 11/12/2007 |