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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