Individual
DR. SHANE ANTHONY WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1802 ROCKINGHAM AVE, BOWLING GREEN, KY 42104-3348
(270) 783-0064
(270) 901-1997
Mailing address
1938 LYDA AVENUE, BOWLING GREEN, KY 42104
(270) 783-0064
(270) 901-1997
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
9943
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
332
OK
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
9422
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
9943
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528342
—
TN
Enumeration date
07/31/2008
Last updated
07/21/2022
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