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Organization
WILLIAMS DENTAL SOUTH
Active
Organization
WILLIAMS DENTAL SOUTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES IVAN WILLIAMS SR. DDS (DENTIST)
(972) 576-0248
Entity
Organization
Contact information
Practice address
269 E. OVILLA RD., STE: 300, RED OAK, TX 75154
(972) 576-0248
(972) 576-0346
Mailing address
269 E. OVILLA RD., BOX 300, RED OAK, TX 75154
(972) 576-3603
(972) 576-3664
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8495
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0079JM
BLUE CROSS BLUE SHIELD
TX
01
—
01364233
UNITED CONCORDIA
TX
01
—
1039831
UNITED HEALTHCARE
TX
05
—
148102001
—
TX
Enumeration date
10/19/2006
Last updated
12/19/2014
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