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Organization
JONESVILLE DENTISTRY, PLLC
Active
Organization
JONESVILLE DENTISTRY, PLLC
Active
Other names
Radiant Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SEAN THERON WILLIAMS DMD (OWNER)
(850) 517-7640
Entity
Organization
Contact information
Practice address
13576 NW 2ND LN STE 30, NEWBERRY, FL 32669-3736
(352) 354-3601
Mailing address
13576 NW 2ND LN STE 30, NEWBERRY, FL 32669-3736
(352) 354-3601
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306376512
NPI - INDIVIDUAL
FL
01
—
DN22573
FLORIDA BOARD OF DENTISTRY
FL
Enumeration date
04/15/2020
Last updated
04/15/2020
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