Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 9943 | KY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 332 | OK |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 9422 | TN |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9943 | KY |
NPI | 1437315272 |
---|---|
Provider Name | Dr. Shane Anthony Williams |
First Address | Bowling Green, KY 42104 |
Second Address | Bowling Green, KY 42104-3348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1528342 | (05) | TN |