Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DS037194 | PA |
NPI | 1073832986 |
---|---|
Provider Name | Dr. Kelly Bolden Williams |
First Address | Pittsburgh, PA 15213-2523 |
Second Address | Pittsburgh, PA 15213-2523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 14/01/2011 |