Organization Active NPI

Robert L Williamson, III, DDS3, PA

  • Dentist
  • Wilmington, NC
National Provider Identifier
1063584282
Registry record updated Jul 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8999 Issued in NC
Legal business name
ROBERT L WILLIAMSON, III, DDS3, PA
Practice address
1624 Princess St
Wilmington, NC 28401-3848
Phone
(910) 251-8174
Fax
(910) 341-3037
NPI assigned
Nov 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nancy Campbell
Title
Regional Manager
Phone
(919) 624-7207

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 7986 NC
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 8411 NC
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 8852 NC
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 8999 NC Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 260100 NC
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 7038 NC

Addresses

Primary practice location

1624 Princess St
Wilmington, NC 28401-3848

Mailing address

1624 Princess St
Wilmington, NC 28401-3848
Phone (910) 251-8174

Other identifiers 4

IdentifierTypeStateIssuer
2058663MedicaidNC
5901114MedicaidNC
89902EJMedicaidNC
5907981MedicaidNC

Other names 1

  • Wilmington Comprehensive & Cosmetic Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277942400000",
    "number": "1063584282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 PRINCESS ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284013848",
            "telephone_number": "910-251-8174",
            "fax_number": "910-341-3037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 PRINCESS ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284013848",
            "telephone_number": "910-251-8174",
            "fax_number": "910-341-3037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT L WILLIAMSON, III, DDS3, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2010-07-01",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "919-624-7207"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "7986",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "8411",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "8852",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "8999",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "260100",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7038",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2058663",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901114",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89902EJ",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5907981",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilmington Comprehensive & Cosmetic Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.