Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 3675 | WV |
NPI | 1013008853 |
---|---|
Provider Name | Mrs. Laura Cox Williams |
First Address | Princeton, WV 24740-3626 |
Second Address | Princeton, WV 24740-3626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 24/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810003005 | (05) | WV |