# A-1 MEDICAID DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932484649
- **Authorized official:** STEPHEN KENT WILLIAMS DDS (PRESIDENT)
- **Authorized official phone:** (812) 735-2121

## Contact information

- **Practice address:** 610 W 11TH ST, BICKNELL, IN 47512-9627
- **Practice address phone:** (812) 735-2121
- **Mailing address:** 610 W 11TH ST, BICKNELL, IN 47512-9627
- **Mailing address phone:** (812) 735-2121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7704IN | IN | — |
| 1223G0001X | General Practice Dentistry | 7719IN | IN | Yes |

## Other

- **Enumeration date:** 10/13/2011
- **Last updated:** 10/13/2011