Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 480920066 | KS |
NPI | 1457387359 |
---|---|
Provider Name | Dr. Michael Neal Williams |
First Address | Wichita, KS 67208-1601 |
Second Address | Wichita, KS 67208-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100221620A | (05) | KS |