Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11741 | TX |
NPI | 1003929076 |
---|---|
Provider Name | Dr. Stephen Williams |
First Address | Cypress, TX 77433-2289 |
Second Address | Cypress, TX 77433-2289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |