Organization
A-1 MEDICAID DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN KENT WILLIAMS DDS (PRESIDENT)
(812) 735-2121
Entity
Organization
Contact information
Practice address
610 W 11TH ST, BICKNELL, IN 47512-9627
(812) 735-2121
Mailing address
610 W 11TH ST, BICKNELL, IN 47512-9627
(812) 735-2121
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
7704IN
IN
1223G0001X
General Practice Dentistry
Primary
7719IN
IN
Other
Enumeration date
10/13/2011
Last updated
10/13/2011
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